Learning to trust others?

[Noyac]

I got to thinking today how some folks will leave unfinished business with partners to take care of and others stick around to finish the ask.

A couple scenarios:
1) You have a pt in the pacu who is nauseated and you can't get control of.
2) same type of scenario except pt is in pain and you are unable to control it.
3) post-op pt can't maintain sats >90 and is supposed to go home.

You could add any other type of scenario. The question is, its 6pm do you inform the call person at the end of the day of your pt and let him/her deal with the pt? Or do you stick around until problem solved?

I don't think there is a right or wrong answer here, just curious. It is something I have found in PP that comes up from time to time. And I notice people approach it differently.

---

Members don't see this ad.

 

[pd4emergence]

I got to thinking today how some folks will leave unfinished business with partners to take care of and others stick around to finish the ask.

A couple scenarios:
1) You have a pt in the pacu who is nauseated and you can't get control of.
2) same type of scenario except pt is in pain and you are unable to control it.
3) post-op pt can't maintain sats >90 and is supposed to go home.

You could add any other type of scenario. The question is, its 6pm do you inform the call person at the end of the day of your pt and let him/her deal with the pt? Or do you stick around until problem solved?

I don't think there is a right or wrong answer here, just curious. It is something I have found in PP that comes up from time to time. And I notice people approach it differently.

1 and 2 maybe, depending on the partner and the current state of affairs (how busy they are). Neither are lifethreatening. If the call person is busy and does not look like they will have time to follow up or arrange admission I would stay until all the fires are put out. As for scenario 3, I would not pass this off unless all workup had been finished, consults if needed followed up, and admission arranged, and the patient was stable in the PACU awaiting a bed. I do have one or two partners that seem to sort of slip out before the feces hits the fan. I would sometimes like to return the favor but can't quite bring myself to do it. I don't think slinking out the door and hoping the call person will handle it is good patient care.

 

[Noyac]

I don't think slinking out the door and hoping the call person will handle it is good patient care.

I'm not really talking about dumping on your partner in the manner you speak. Slinking out the door. I'm talking more about checking out to the call person and letting them deal with the issue. Are you comfortable leaving issues like these and others with your partners?

The reason I ask is b/c one of my partners had a kid who couldn't maintain his sats after a T&A. I wasn't on call so I'm out of the picture but he didn't leave it for the call guy after ordering the CXR, calling the surgeon to inform him and whatever. The kid was perfectly stable but in my opinion not suited for discharge. Personally, I'd have arranged for admission for the kid and handed him off to the call guy to follow up on as long as the kid is stable. Agree or disagree? There was a time were I wouldn't have handled it this way and would have had a difficult time handing it over. I wanted to take care of everything myself.

 

[coprolalia]

Noy, perhaps you could give us some examples of how you would handle those scenarios.

-copro

 

[Planktonmd]

I'm not really talking about dumping on your partner in the manner you speak. Slinking out the door. I'm talking more about checking out to the call person and letting them deal with the issue. Are you comfortable leaving issues like these and others with your partners?

The reason I ask is b/c one of my partners had a kid who couldn't maintain his sats after a T&A. I wasn't on call so I'm out of the picture but he didn't leave it for the call guy after ordering the CXR, calling the surgeon to inform him and whatever. The kid was perfectly stable but in my opinion not suited for discharge. Personally, I'd have arranged for admission for the kid and handed him off to the call guy to follow up on as long as the kid is stable. Agree or disagree? There was a time were I wouldn't have handled it this way and would have had a difficult time handing it over. I wanted to take care of everything myself.

Noy,

I would have done the same thing you mentioned.
If I think the patient is stable and everything has been done then I don't see a problem signing him out to someone else.

 

[pd4emergence]

I'm not really talking about dumping on your partner in the manner you speak. Slinking out the door. I'm talking more about checking out to the call person and letting them deal with the issue. Are you comfortable leaving issues like these and others with your partners?

The reason I ask is b/c one of my partners had a kid who couldn't maintain his sats after a T&A. I wasn't on call so I'm out of the picture but he didn't leave it for the call guy after ordering the CXR, calling the surgeon to inform him and whatever. The kid was perfectly stable but in my opinion not suited for discharge. Personally, I'd have arranged for admission for the kid and handed him off to the call guy to follow up on as long as the kid is stable. Agree or disagree? There was a time were I wouldn't have handled it this way and would have had a difficult time handing it over. I wanted to take care of everything myself.

I think if admission had been arranged and the kid was stable and waiting on a bed, I would have no problem handing this off to the call person. I would make sure most of the workup had been done and admission had been arranged, not because I don't trust the call guy to do it but because I feel like it is my responsibility to make sure that stuff had been taken care of. I trust nearly all of my partners to do what needs to be done. I just try not to hand off anything I would not want them to hand off to me.

 

[Noyac]

I think if admission had been arranged and the kid was stable and waiting on a bed, I would have no problem handing this off to the call person. I would make sure most of the workup had been done and admission had been arranged, not because I don't trust the call guy to do it but because I feel like it is my responsibility to make sure that stuff had been taken care of. I trust nearly all of my partners to do what needs to be done. I just try not to hand off anything I would not want them to hand off to me.

Thats fine. Lets say you have ordered the necessary test and called for the consults but the everything hasn't been completed. The pt is stable but awaiting further workup. Will you check out to the call person (asuming the call person is not totally swamped) and let him/her complete the tasks.

After all the call person may come to relieve you from a case in the OR. Do you feel comfortable or do you feel that it is appropriate to have them relieve you on something like this?

 

[Noyac]

Noy, perhaps you could give us some examples of how you would handle those scenarios.

-copro

Before I comment I'll say that all scenarios are non life threatening and the pts are stable. The call person is not swamped but just on call with maybe some basic cases to do.
Scenario #1, I'd be fine leaving this for my partner to followup on. I'd give my impression and what interventions I have attempted. This person may need admission to control the nausea or it may resolve. I don't need to hang out waiting for this to occur.
Scenario #2, I would make every attempt to get the pt comfortable including regional b/4 handing it off. My partner must be comfortable with the scenario This goes for every scenario.
Scenario #3, this is were I'd be damn sure the pt is stable. I'd talk to the call person and get their opinion on taking over the case.

I will say that if I am on call I would expect my partners to feel like they could hand these things over to me. I started this thread b/c there was a time when I wasn't comfortable handing over fro a few reasons. One I didn't want to be thought of as dumping on my partner. And secondly, I felt I needed to complete the task and wasn't sure what kind of care the pt would receive after I it handed over. I was then told by one of my previous partners that everyone here is qualified to take care of these scenarios or else they wouldn't be here. If I didn't leave work when it was my turn then I would find myself working more than necessary. I will have plenty of opportunities to stay late. And plenty of opportunities to repay the partner.

I didn't want to give my opinions here, in case I influenced others here and really was interested in the general opinions and what others did in this case. This is probably a good thing to ask your future groups when interviewing as well.

 

[pd4emergence]

Thats fine. Lets say you have ordered the necessary test and called for the consults but the everything hasn't been completed. The pt is stable but awaiting further workup. Will you check out to the call person (asuming the call person is not totally swamped) and let him/her complete the tasks.

After all the call person may come to relieve you from a case in the OR. Do you feel comfortable or do you feel that it is appropriate to have them relieve you on something like this?

If one of my partners came to me with this scenario, It would not bother me to take it over. I would want to know about the case and what I needed to followup. I do think that the person that did the case should talk to the people they consult and the surgeon for the case. As far as for me, I would be ok to turn it over after I felt like I had ruled out all of the major badness I could think of and I felt like the patient was stable and not going to crump. If the call guy had any hesitation (one or two of my partners would) then I would stick around.