Your worst bounceback cases

[dozitgetchahi]

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I can tell you would even scarier story ironically from the same site about how a third of my ER got quietly shuffled out to other jobs over a single case where the ER was the only people who did the right thing, but only patient/family perception matters.

Old woman comes in and registers as anxiety. On a superficial level, she does look very anxious and says that she used up the last of her Ativan this morning, but she still feels super anxious and needs an immediate IV injection as well as meter refill 30 days worth of it. I tell her that I'm happy to address the anxiety, but I'm not going to refill 30 days of it. She begins screaming and having a fit. I tell her that we're more than happy to start some ad event, but I just want to get blood work and EKG done first because she looks almost a little too sweaty for it to just be anxiety. That I think she might be having a cardiac event. She curses me out that I'm just trying to judge her and that she's not an addict and then I'm just playing games with her to not give her the Ativan. I document all of this conversation.

She elopes from the ER. Within a minute or two of that conversation

About 20 minutes later she checks back in and registers as medication refill. Sees my partner. I point out that sprinted out last time. Partner reorders all my same Labs except he orders an Ativan bolus immediately. She gets the Ativan and gets her blood drawn and gets her EKG. EKG is grossly ischemic. No infarct, but definitely ischemic. She's demanding more Ativan saying that the first dose didn't do s***. My partner attempts to explain to her that he thinks she's having a heart attack. She says that he went to a clown college and that everyone here is judging her and elopes.

We call the family and let them know that we think she's having a heart attack and that she's probably on her way home. We called the police and let them know that an old woman who just got a big bolus of Ativan is probably skidding all over the road right now.

About 2 hours later, the family brings her in and she sees a third ER doctor as the shift change has occurred. She gets an absolute metric ton of Ativan and gets admitted for an NSTEMI as that was the ultimate diagnosis and trops kept rising. And in fact, a repeat EKG shows less ischemia than the first one.

She gets admitted. Spends 2 days upstairs before they finally decide to do the cath. The cath is reported as being completely clean (never did figure out why she was having the NSTEMI) but she ends up having a respiratory arrest during the cath. Apparently she was so difficult to keep calm for the cath that the head of anesthesia had to be involved in order to give significant amounts of sedation during the procedure and she became apneic. I won't point fingers cause don't know what actually happened, but the rumor within in the facility is that everyone sort of agreed that she wasn't a good candidate to do a cath and her trops were going down so no one really wanted to do it but the family kept pushing for it and maybe they knew someone. So the head of hospitalists medically cleared her. And the head of anesthesiology sedated her. And the head of cardiology did the cath. And she died during a probably unnecessary Cath.

So what was the outcome? All the family remembered is the wonderful inpatient team said she can get all the Ativan she wanted while the last thing mom said before she got admitted (after the second elopement) was how horrible the ER was to not give her enough Ativan. The three of us get brought to risk management who, honestly, doesn't know why any of us are there and tells us not to worry. But by a month later, the reality is that the CMO is pulling us off of shifts constantly to 2nd, 3rd and 4th guess are management of tons of bread and butter cases. Then we all end up on improvement plans. Eventually, our director tells us that he decided to finally ask what the hell was going on and it turns out that the family has made it abundantly clear that they will not sue if the ER doctors take the fall and the hospital can't find a way to get us to leave but doesn't want to fire us per se for legal exposure of their own ass reasons.

The world is a wonderfully backwards place

Horrifying. Also, never underestimate admin’s willingness to play weird reindeer games.

 

[Apollyon]

She says that he went to a clown college and that everyone here is judging her and elopes.

(never did figure out why she was having the NSTEMI)

Two things: since you're in FL, did she say "clown college", or actually name check Ringling Bros.?

Second, Takotsubo cardiomyopathy? I had this lady one morning, on vacation in the woods with her husband. STEMI on EKG, positive trop. I recall telling her something to the effect of, "I know it's a total bummer to be on vacation, away from home, and have a heart attack, but that's what it looks like is going on". Have to send her to the big house.

Get a text later from Pat, the cards dude. He says, "Clean Cath. Takotsubo."

 

[Porfirio]

I can tell you would even scarier story ironically from the same site about how a third of my ER got quietly shuffled out to other jobs over a single case where the ER was the only people who did the right thing, but only patient/family perception matters.

Old woman comes in and registers as anxiety. On a superficial level, she does look very anxious and says that she used up the last of her Ativan this morning, but she still feels super anxious and needs an immediate IV injection as well as meter refill 30 days worth of it. I tell her that I'm happy to address the anxiety, but I'm not going to refill 30 days of it. She begins screaming and having a fit. I tell her that we're more than happy to start some ad event, but I just want to get blood work and EKG done first because she looks almost a little too sweaty for it to just be anxiety. That I think she might be having a cardiac event. She curses me out that I'm just trying to judge her and that she's not an addict and then I'm just playing games with her to not give her the Ativan. I document all of this conversation.

She elopes from the ER. Within a minute or two of that conversation

About 20 minutes later she checks back in and registers as medication refill. Sees my partner. I point out that sprinted out last time. Partner reorders all my same Labs except he orders an Ativan bolus immediately. She gets the Ativan and gets her blood drawn and gets her EKG. EKG is grossly ischemic. No infarct, but definitely ischemic. She's demanding more Ativan saying that the first dose didn't do s***. My partner attempts to explain to her that he thinks she's having a heart attack. She says that he went to a clown college and that everyone here is judging her and elopes.

We call the family and let them know that we think she's having a heart attack and that she's probably on her way home. We called the police and let them know that an old woman who just got a big bolus of Ativan is probably skidding all over the road right now.

About 2 hours later, the family brings her in and she sees a third ER doctor as the shift change has occurred. She gets an absolute metric ton of Ativan and gets admitted for an NSTEMI as that was the ultimate diagnosis and trops kept rising. And in fact, a repeat EKG shows less ischemia than the first one.

She gets admitted. Spends 2 days upstairs before they finally decide to do the cath. The cath is reported as being completely clean (never did figure out why she was having the NSTEMI) but she ends up having a respiratory arrest during the cath. Apparently she was so difficult to keep calm for the cath that the head of anesthesia had to be involved in order to give significant amounts of sedation during the procedure and she became apneic. I won't point fingers cause don't know what actually happened, but the rumor within in the facility is that everyone sort of agreed that she wasn't a good candidate to do a cath and her trops were going down so no one really wanted to do it but the family kept pushing for it and maybe they knew someone. So the head of hospitalists medically cleared her. And the head of anesthesiology sedated her. And the head of cardiology did the cath. And she died during a probably unnecessary Cath.

So what was the outcome? All the family remembered is the wonderful inpatient team said she can get all the Ativan she wanted while the last thing mom said before she got admitted (after the second elopement) was how horrible the ER was to not give her enough Ativan. The three of us get brought to risk management who, honestly, doesn't know why any of us are there and tells us not to worry. But by a month later, the reality is that the CMO is pulling us off of shifts constantly to 2nd, 3rd and 4th guess are management of tons of bread and butter cases. Then we all end up on improvement plans. Eventually, our director tells us that he decided to finally ask what the hell was going on and it turns out that the family has made it abundantly clear that they will not sue if the ER doctors take the fall and the hospital can't find a way to get us to leave but doesn't want to fire us per se for legal exposure of their own ass reasons.

The world is a wonderfully backwards place

This is the world we work to try and save.

 

[TooMuchResearch]

I can tell you would even scarier story ironically from the same site about how a third of my ER got quietly shuffled out to other jobs over a single case where the ER was the only people who did the right thing, but only patient/family perception matters.

Old woman comes in and registers as anxiety. On a superficial level, she does look very anxious and says that she used up the last of her Ativan this morning, but she still feels super anxious and needs an immediate IV injection as well as meter refill 30 days worth of it. I tell her that I'm happy to address the anxiety, but I'm not going to refill 30 days of it. She begins screaming and having a fit. I tell her that we're more than happy to start some ad event, but I just want to get blood work and EKG done first because she looks almost a little too sweaty for it to just be anxiety. That I think she might be having a cardiac event. She curses me out that I'm just trying to judge her and that she's not an addict and then I'm just playing games with her to not give her the Ativan. I document all of this conversation.

She elopes from the ER. Within a minute or two of that conversation

About 20 minutes later she checks back in and registers as medication refill. Sees my partner. I point out that sprinted out last time. Partner reorders all my same Labs except he orders an Ativan bolus immediately. She gets the Ativan and gets her blood drawn and gets her EKG. EKG is grossly ischemic. No infarct, but definitely ischemic. She's demanding more Ativan saying that the first dose didn't do s***. My partner attempts to explain to her that he thinks she's having a heart attack. She says that he went to a clown college and that everyone here is judging her and elopes.

We call the family and let them know that we think she's having a heart attack and that she's probably on her way home. We called the police and let them know that an old woman who just got a big bolus of Ativan is probably skidding all over the road right now.

About 2 hours later, the family brings her in and she sees a third ER doctor as the shift change has occurred. She gets an absolute metric ton of Ativan and gets admitted for an NSTEMI as that was the ultimate diagnosis and trops kept rising. And in fact, a repeat EKG shows less ischemia than the first one.

She gets admitted. Spends 2 days upstairs before they finally decide to do the cath. The cath is reported as being completely clean (never did figure out why she was having the NSTEMI) but she ends up having a respiratory arrest during the cath. Apparently she was so difficult to keep calm for the cath that the head of anesthesia had to be involved in order to give significant amounts of sedation during the procedure and she became apneic. I won't point fingers cause don't know what actually happened, but the rumor within in the facility is that everyone sort of agreed that she wasn't a good candidate to do a cath and her trops were going down so no one really wanted to do it but the family kept pushing for it and maybe they knew someone. So the head of hospitalists medically cleared her. And the head of anesthesiology sedated her. And the head of cardiology did the cath. And she died during a probably unnecessary Cath.

So what was the outcome? All the family remembered is the wonderful inpatient team said she can get all the Ativan she wanted while the last thing mom said before she got admitted (after the second elopement) was how horrible the ER was to not give her enough Ativan. The three of us get brought to risk management who, honestly, doesn't know why any of us are there and tells us not to worry. But by a month later, the reality is that the CMO is pulling us off of shifts constantly to 2nd, 3rd and 4th guess are management of tons of bread and butter cases. Then we all end up on improvement plans. Eventually, our director tells us that he decided to finally ask what the hell was going on and it turns out that the family has made it abundantly clear that they will not sue if the ER doctors take the fall and the hospital can't find a way to get us to leave but doesn't want to fire us per se for legal exposure of their own ass reasons.

The world is a wonderfully backwards place

Um what the **** did I just read.

 

[DocEspana]

Um what the **** did I just read.

What you read is the reason why I celebrated when envision went broke. Technically my quarrel should be with HCA, but the fact that envision didn't bother to try too defend anyone involved at all and just told us that this is the business and tough titties always rubbed me the wrong way. The company told me they're happy to place me at another site almost 2 hours away. Thankfully my director said that he was going to set stuff as right as he could and called in favors to place me at the hospital unrelated to envision that was actually 15 minutes closer to my house.

It's a lesson on how ridiculous the system can be if you're unlucky. That's what you read.

 

[TooMuchResearch]

Wtf

 

[Porfirio]

HCA baby, what happens when MBA suits and clipboard nurses take over.

 

[hoot504]

Um what the **** did I just read.

Seriously. At the risk of sounding naive, lawyer up? Absolute bull****.