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[neusu]

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Looking for some perspective here.

I have had several interactions with both attendings and residents at my academic institution wherein I either call the provider directly or get a call-back regarding a patient re: dispo and the sum of the conversation on the ED end is "I got this patient on sign-out."

For the former, I am typically calling to ask a pertinent question regarding the management of the patient in the ED and the answer uniformly is "I do not know the current exam, I was told.."

For the latter, again the person calling has never seen the patient and is in no way able to update me on the current status.

Is this common practice? When I sign out with my co-residents I see every patient that is concerning. I see every patient who I need to speak with another physician about. When I call a consult, I have reviewed the H&P, current medications, know the current vitals, exam, and can portray my concern that warrants a consultation from another service.

Am I asking too much?

 

[SoCuteMD]

Your post is really unclear. Is this a patient you've already been consulted on or who has already been admitted and you are calling back for more information? You need to clarify the context.

 

[WilcoWorld]

If I take sign out on a patient who has already been admitted and is stable, I'm not going to see the patient unless something comes up. If you call me with a question, I'll only be able to give you the information I got in sign out. I think that is perfectly acceptable for stable patients on whom report has already been given.

However, if I take sign out on a patient and then have to call a consultant, I make sure to take a look at the patient and familiarize myself with the pertinent details. For instance, if I'm calling the Cardiologist I'll know what the troponin was, how the ECG looks and whether the patient still has chest pain. But I probably won't know the patient's past surgical history and what his cholesterol was 8 months ago.

So, like SCMD said, you need to clarify the context.

 

[pinipig523]

If my name goes on the chart - I see every patient. If I am signed out a patients just as an "FYI, this patient is going up, nothing to do likely, just keep an eye for ER nurses requests for pain meds....".. then I do not see the patient.

But if I'm calling a consult or waiting for one, I will see the patient.

 

[Khaos]

I agree with everyone here. If I'm told the patient is admitted, has been stable for the past however many hours, I don't see the patient. If I have to consult on the patient or dispo is unclear when signed out, I will see the patient, ask the history again, and re-examine the patient. I know this might be amazing but the admitting doc could come down and see the patient if they have questions on the patient they had already received sign out from. If you see every patient signed out to you, pretend this is a patient signed out to you (it pretty much is).

 

[iish]

What kind of physician is the original poster?

 

[dotcb]

What kind of physician is the original poster?

I believe they're in neurosurgery.

My answer is that I would plan to have the relevant details if I'm talking to a consult. Generally I would see the patient and examine them.

Occasionally I would not. Example: There's a patient signed out to me with abdominal pain, RLQ ttp w/ guarding. Waiting on CT A/P for ? appy. CT comes back + for appy. I might not see that patient before calling surgery.

 

[e30ftw]

it's 0230 in the ER..

nsgy calls back about head bleed 2 hours after consult called and first ed doc has gone home:

er doc: "pt is 65 y/o m who p/w HA found to have diffuse SAH on CT currently intubated hunt and hess 4, 4-vessel already ordered, will need ICU admit"

nsgy: "how has his neuro exam changed in the past 15 minutes"

er: "I got sign out on this patient and do not know that.."

nsgy: "er docs are idiots."

RN: "doc, there's a patient in the waiting room who just threw up about 250cc of blood, could you come here for a second?"

meanwhile 5 private paying ESI 4 patients in the waiting room decide to go home because "the waiting room is gross" adding multiple LWBS to the ED's metrics..

 

[Rendar5]

dude, why is the SAH with a head bleed still the ED's pt after 2 hours? that's what's gonna kill your metrics, lol. Sigh, don't miss academic medicine. That pt already left my ED an hour ago. And in the odd event that there's a stuck ICU pt boarding in ED due to no rooms, he's the inpt team's pt anyway, so no one better be asking me about him.