Minor annoyance

[narcusprince]

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Was on call last night. I was annoyed with a communication issue. I was called by a tech on the labor deck that a patient was going to Caserean section. These consults should be made nurse to physician and or physician to physician. This tech could not convey/ emergent/ nonemergent/ or indication for Caserean. I think my hospital communicates very well but we certainly could use some work.

 

[Consigliere]

Common problem indicative of how physicians are perceived: as slobs that anyone can call and tell what to do. And being the good little sheeple that we are, we'll just tuck our tails between our legs, shrug our shoulders, and say "well, it's not worth getting excited over."

 

[Psai]

? Should be physician to physician every time

 

[Planktonmd]

In most places where anesthesiologists don't take in house call, when an obstetrician wants to do a C section, the anesthesiologist has to show up and do it within the acceptable time period which is usually 30 minutes from call to c section.
This is the case regardless of how emergent or non emergent it is. So if you are going to come do it anyway, why make a big deal about who calls you and what they say?
You will get there and find out what's going on and deal with it.
But if your issue is that you feel disrespected or unappreciated because the OB did not call you personally, then you are probably in the wrong line of business and you should have been a real doctor to get that respect that you want. This train has left the station long time ago!

 

[narcusprince]

In most places where anesthesiologists don't take in house call, when an obstetrician wants to do a C section, the anesthesiologist has to show up and do it within the acceptable time period which is usually 30 minutes from call to c section.
This is the case regardless of how emergent or non emergent it is. So if you are going to come do it anyway, why make a big deal about who calls you and what they say?
You will get there and find out what's going on and deal with it.
But if your issue is that you feel disrespected or unappreciated because the OB did not call you personally, then you are probably in the wrong line of business and you should have been a real doctor to get that respect that you want. This train has left the station long time ago!

Plankton
Call is taken in-house. The chain of information should at least come from a nurse that conveys emergent or nonemergent and indication. A tech is not capable of conveying those things. This changes management an emergency section you run upstairs and handle business. If its non-emergent and for failure to arrest then thats a different story(still going to do the case). I understand we get minimilized in our profession. We have to demand to be a consultant based practice versus tech(table up table down)practice.

 

[twoliter]

In most places where anesthesiologists don't take in house call, when an obstetrician wants to do a C section, the anesthesiologist has to show up and do it within the acceptable time period which is usually 30 minutes from call to c section.
This is the case regardless of how emergent or non emergent it is. So if you are going to come do it anyway, why make a big deal about who calls you and what they say?
You will get there and find out what's going on and deal with it.
But if your issue is that you feel disrespected or unappreciated because the OB did not call you personally, then you are probably in the wrong line of business and you should have been a real doctor to get that respect that you want. This train has left the station long time ago!

Even if I'm in house, I would still like to know if we're talking about a thin, healthy failure-to-progress with a working labor epidural or a morbidly obese percreta with bleeding that just came through the door. Even if only for the short walk/run to L&D, I'd like to be coming up with a plan and getting mentally prepared.

 

[Phyrst]

I can see Plankton's point of view, but it is annoying. In a high-risk center, I can't even get a phone call from the OB residents anymore. And, if I need to activate blood products, put in lines, etc., having a conversation with someone who has the slightest idea what's going on can have a significant impact in the flow of care.

 

[pgg]

That's not OK. Talk to the OBs. They need to know that you're not getting the necessary information.

If they're not tools, they'll fix the problem with more direct communication.

If they are tools and don't see a problem, PSR it. It's a safety risk. Sic the machine on them and CYA.

 

[Noyac]

We fixed this at our facility many years ago. Our requirement is physician to physician because it is in the hospital bylaws that all consults, which is what this is, are to be made this way. You can't just write an order for cardiology to see the pt just like you can't just call anesthesiology to come in. There must be some communication in order for good care to be rendered.
But we still get the tech or nurse call from OB from time to time. Usually because the OB is elbow deep in a vagina or something like that and can't pick up the phone personally. I just assume that if a tech is calling then it is a real emergency and I am on my way. If I'm wrong then we have a very clear discussion after the case, which I haven't had to do in years.

 

[Urzuz]

I understand we get minimilized in our profession. We have to demand to be a consultant based practice versus tech(table up table down)practice.

So what did you say? Or what are you going to do to address the problem?

Use this as an opportunity to change the culture.

 

[Hoya11]

You are not the only one annoyed by this. I think the issue is that SUCH a possibly urgent/important message is entrusted to the lowest rank of employee in the hospital so it feels wierd to be on the receiving end. What we did was have a class 1, 2, 3 system for communicating urgency through the OB secretary. IE, "Page anesthesia we have a class 1 section"

 

[pjl]

For emergencies, we are called on purpose by the unit secretary, with no medical knowledge. They have a list of information they need to be able to give us when we call them back, which lets you know the situation, and speed you need to get there. OBs and nurses are getting the patient into the room, hooking up monitors, and if truly stat they sometimes will preoxygenate.

We do have the extension of the OB in our heads and call if there is anything that doesnt make sense or missing information. I dont see it as a lack of respect, more a efficiency of time.

For non-stat sections I get paged to the OBs phone, or rarely the nurse will give me a heads up when I am walking around.


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[Orin]

Yeah, my favorite notification was an AROM with cord prolapse that I noticed was rushing to the ORs as I was grabbing some hospital soda.

Regardless, would be ideal to have a stat section button that automatically alerts a team to emergent stuff and some verbal communication when it's urgent. I don't care if it's a med student or the doula as it isn't about the respect issue; it's just a safety problem.

 

[pjl]

Create the following at your hospital:
1. 3 different levels of c-section-
1 Immediate, immediate threat of life to baby or mom. ASAP goal
2 Needs to go soon but not running. 30 min goal
3 Some time today, when convenient. <8 hours or whatever

2. Stat OB team-Basically batch page all the people required for #1 above or for in room code on OB floor

It is a pain to form, but it actually improves care and communication. Make sure they have some level of review for the level 1 and 2 calls so that they arent always calling for the level 2 because it is the end of the day. We actually have a lot less headaches after doing this.

I forget the whole list that they have to give to the unit secretary, but basically they can tell us what level of urgency it is, whether they have an epidural, indication for c section (in vague terms), BMI, and a couple of other things.

 

[amyl]

My old pp gig required doc to doc communication......