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Intrahospital Transfer
Andy Brainard trauma-list@trauma.orgWed, 22 Jan 2003 20:04:50 -0700
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This is a multi-part message in MIME format. ------=_NextPart_000_004F_01C2C251.8978F3A0 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: quoted-printable When I'm admitted into the psych ward (for psychosis related to the = trauma list) and I manage to take a overdose and slit my wrists (just to make = it trauma related), I would like to be transferred to a well staffed ED for rapid triage and treatment. In my limited experience, the ED is more = able to quickly adapt and decide what type of care this patient needs. If the = ICU feels like they would like to handle this type of patient it would be = fine to give transfer them there, but my guess is that both the ICU and psych staff felt more comfortable letting the OD experts in the ED handling = this one.=20 =20 I am curious what the new policy will say about in-patients who jump = from the roof. =20 I do think that this is a reasonably relative discussion (compared to = some), and I'm also pretty sure that Pret and Andrew can take care of = themselves. Maybe the tone of the debate is a little too shrill, but it has been entertaining and informative. If people can't handle their enlightenment with a little bit of vinegar, then maybe they should be off the list. = Maybe they should have an email conversation with Canada's number one twin? = (Just kidding) =20 Andy Brainard =20 -----Original Message----- From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org] = On Behalf Of Jeffrey A Murphy Sent: Wednesday, January 22, 2003 5:23 PM To: trauma-list@trauma.org Subject: RE: Intrahospital Transfer =20 Speaking as an ICU nurse, I will support Andrew. I for one, would pass = on taking care of an overdose ANY day! I'm curious as to why this patient = only needed a 4 hour monitoring period, what was the overdose, and if that is = all the patient needed, why did they need to to go to the ER. -----Original Message----- From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org] = On Behalf Of Bjorn, Pret Sent: Wednesday, January 22, 2003 3:03 PM To: 'trauma-list@trauma.org' Subject: RE: Intrahospital Transfer Andrew, =20 I've tried to be understanding, but this is foolishness. =20 =20 Each of the alternate inpatient scenarios you've constructed (post-code, = PE, fresh MI) are quintessential ICU patients: they're critically ill, = medically screened, have readily-identifiable medical doctors (wait--do your psychiatrists enjoy ICU privileges?), and they're predictably cooperative--or at least not demonstrably self-destructive. ICU nurses = love these guys. Sadly, the overdose you describe bears pretty much NO resemblance to these hypotheticals. Just guessing here, but during the actual case progression, your ICU colleagues didn't rush to support you, = did they? =20 Think carefully for a moment: you're insisting on a four-hour ICU = admission for a patient who, if treated promptly and appropriately, would = otherwise have no need whatsoever for conventional ICU care. Have you any idea = what the room charge is for four hours in the ICU? (Hint: it's precisely the same as twenty-four hours in the ICU). But then, I guess we're only = worrying about costs to the extent that they impact your ED... =20 Finally, the question begs to be asked: if the ICU is a better place for this overdose than the ED, then why don't you just add ten beds to the = ICU and send all your overdoses there? Cardiacs, strokes, pulmonaries, traumas... Where's the line? Inpatients? Meaning that if somebody = jumps from the roof, we should cart him to the Unit? Hell, add THIRTY unit = beds, and CLOSE the silly ED. Beats trying to keep track of what an emergency = is this week. =20 It's comforting that if the opinions of the ICU nurses on the list count = for anything, they'd probably take pride in demonstrating the sort of functionality and flexibility that you discourage in your Emergency Department. Sigh. =20 Seems about the only thing you and I can agree on is that this is has nothing to do with trauma. Let's go off-list, or better, retreat to our corners and wait for a more appropriate thread. =20 Pret =20 -----Original Message----- From: Andrew J Bowman [mailto:sumieb@compuserve.com] Sent: Tuesday, January 21, 2003 5:01 PM To: trauma-list@trauma.org Subject: Re: Intrahospital Transfer Wow, guess I touched a nerve. =20 >From one seasoned ER nurse to another I respect your input. All that is except for the name calling, but since I have worked in an ER for over = 20 years I have been referred to and called much worse. =20 I am always now and have always been the one to say "Treat the patient" = But come on. Sending a patient from the floor to the ER for care. Sure it = says a lot for me and my staff and very little for the hospital ICU. If the = ICU cannot handle emergencies then why are they wasting their time training = to be ready to take care of emergencies. =20 When a patient on the floor codes and gets resuscitated where do they = go??? Yep, ICU. =20 When a patient on the floor throws a post-op PE and goes into = respiratory failure where do they go??? Yep again, the ICU. =20 When a patient on the floor goes from unstable angina to ST elevation MI where do they go? Yep, the cath lab and then to the ICU. =20 So WHY, WHY, WHY should this patient be treated any = differently???????????? The ICU is wide open, the patient has a POTENTIALLY bad situation form = the OD and needs close observation, frequent reassessments and cardiac monitoring. Hmmmmmmmmmmm, sounds like ICU in my neck of the woods. =20 Plus at my facility the ED is much easier to escape from than the ICU = since we are not a locked unit (neither is our ICU but a camera watches the patient 24/7 and the monitor tech can alert the staff immediately if the patient who is suicidal decides to elope). So if they want to escape = there are 2 wide open doors to do it from and then right out to the street. =20 Plus you promoted the idea of influx when you said that the ED is the = best place to refer an emergency condition. If we do that then we will have = to decide, does this patient have enough of an "emergency" to go to ER or should she/he just go to ICU? =20 Inpatients are inpatients, outpatients are outpatients. =20 I have spent shifts in my ICU and OR and floors to know how busy they = are and what they are designed to do. Inpatients who go bad go to ICU, not backwards to the ER. =20 Andrew B ------=_NextPart_000_004F_01C2C251.8978F3A0 Content-Type: text/html; charset="us-ascii" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <html> <head> <META HTTP-EQUIV=3D"Content-Type" CONTENT=3D"text/html; = charset=3Dus-ascii"> <meta name=3DGenerator content=3D"Microsoft Word 10 (filtered)"> <title>Message</title> <style> <!-- /* Font Definitions */ @font-face {font-family:Tahoma; panose-1:2 11 6 4 3 5 4 4 2 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:12.0pt; font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline;} span.EmailStyle19 {font-family:Arial; color:navy;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.Section1 {page:Section1;} --> </style> </head> <body bgcolor=3Dwhite lang=3DEN-US link=3Dblue vlink=3Dpurple> <div class=3DSection1> <p class=3DMsoNormal style=3D'text-indent:.5in'><font size=3D2 = color=3Dnavy face=3DArial><span style=3D'font-size:10.0pt;font-family:Arial;color:navy'>When I’m = admitted into the psych ward (for psychosis related to the trauma list) and I = manage to take a overdose and slit my wrists (just to make it trauma related), I = would like to be transferred to a well staffed ED for rapid triage and = treatment. In my limited experience, the ED is more able to quickly adapt and decide what = type of care this patient needs. If the ICU feels like they would like to = handle this type of patient it would be fine to give transfer them there, but = my guess is that both the ICU and psych staff felt more comfortable letting the = OD experts in the ED handling this one. </span></font></p> <p class=3DMsoNormal style=3D'text-indent:.5in'><font size=3D2 = color=3Dnavy face=3DArial><span style=3D'font-size:10.0pt;font-family:Arial;color:navy'> </span></fo= nt></p> <p class=3DMsoNormal style=3D'text-indent:.5in'><font size=3D2 = color=3Dnavy face=3DArial><span style=3D'font-size:10.0pt;font-family:Arial;color:navy'>I am curious = what the new policy will say about in-patients who jump from the = roof.</span></font></p> <p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:navy'> </span></font></p> <p class=3DMsoNormal style=3D'text-indent:5.25pt'><font size=3D2 = color=3Dnavy face=3DArial><span = style=3D'font-size:10.0pt;font-family:Arial;color:navy'>I do think that this is a reasonably relative discussion (compared to some), = and I’m also pretty sure that Pret and Andrew can take care of themselves. Maybe = the tone of the debate is a little too shrill, but it has been entertaining = and informative. If people can’t handle their enlightenment with a = little bit of vinegar, then maybe they should be off the list. Maybe they should = have an email conversation with </span></font><font size=3D2 color=3Dnavy = face=3DArial><span = style=3D'font-size:10.0pt;font-family:Arial;color:navy'>Canada</span></fo= nt><font size=3D2 color=3Dnavy face=3DArial><span = style=3D'font-size:10.0pt;font-family:Arial; color:navy'>’s number one twin? (Just kidding)</span></font></p> <p class=3DMsoNormal style=3D'text-indent:5.25pt'><font size=3D2 = color=3Dnavy face=3DArial><span = style=3D'font-size:10.0pt;font-family:Arial;color:navy'> </span></fo= nt></p> <p class=3DMsoNormal style=3D'text-indent:5.25pt'><font size=3D2 = color=3Dnavy face=3DArial><span = style=3D'font-size:10.0pt;font-family:Arial;color:navy'>Andy Brainard</span></font></p> <p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:navy'> </span></font></p> <div style=3D'border:none;border-left:solid blue 1.5pt;padding:0in 0in = 0in 4.0pt'> <p class=3DMsoNormal><font size=3D2 face=3DTahoma><span = style=3D'font-size:10.0pt; font-family:Tahoma'>-----Original Message-----<br> <b><span style=3D'font-weight:bold'>From:</span></b> = trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org] <b><span = style=3D'font-weight:bold'>On Behalf Of </span></b>Jeffrey A Murphy<br> <b><span style=3D'font-weight:bold'>Sent:</span></b> Wednesday, January = 22, 2003 5:23 PM<br> <b><span style=3D'font-weight:bold'>To:</span></b> = trauma-list@trauma.org<br> <b><span style=3D'font-weight:bold'>Subject:</span></b> RE: = Intrahospital Transfer</span></font></p> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> <div> <p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:blue'>Speaking as an ICU nurse, I will = support Andrew. I for one, would pass on taking care of an overdose ANY day! I'm curious as to why this patient only needed a 4 hour = monitoring period, what was the overdose, and if that is all the patient needed, = why did they need to to go to the ER.</span></font></p> </div> <blockquote = style=3D'margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt'> <p class=3DMsoNormal style=3D'margin-bottom:12.0pt'><font size=3D2 = face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'>-----Original = Message-----<br> <b><span style=3D'font-weight:bold'>From:</span></b> = trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org] <b><span = style=3D'font-weight:bold'>On Behalf Of </span></b>Bjorn, Pret<br> <b><span style=3D'font-weight:bold'>Sent:</span></b> Wednesday, January = 22, 2003 3:03 PM<br> <b><span style=3D'font-weight:bold'>To:</span></b> = 'trauma-list@trauma.org'<br> <b><span style=3D'font-weight:bold'>Subject:</span></b> RE: = Intrahospital Transfer</span></font></p> <div> <p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:maroon'>Andrew,</span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:maroon'>I've tried to be understanding, = but this is foolishness. </span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:maroon'>Each of the alternate inpatient = scenarios you've constructed (post-code, PE, fresh MI) are <em><i><font = face=3DArial><span style=3D'font-family:Arial'>quintessential </span></font></i></em>ICU = patients: they're critically ill, medically screened, have readily-identifiable = medical doctors (wait--do your psychiatrists enjoy ICU privileges?), and they're predictably cooperative--or at least not demonstrably <em><i><font = face=3DArial><span style=3D'font-family:Arial'>self-destructive</span></font></i></em>. = ; ICU nurses love these guys. Sadly, the overdose you describe bears = pretty much NO resemblance to these hypotheticals. Just guessing here, = but during the actual case progression, your ICU colleagues didn't rush to = support you, did they?</span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:maroon'>Think carefully for a moment: you're insisting on a four-hour ICU admission for a patient = who, if treated promptly and appropriately, would otherwise have no need = whatsoever for conventional ICU care. Have you <em><i><font = face=3DArial><span style=3D'font-family:Arial'>any </span></font></i></em>idea = what the room charge is for four hours in the ICU<em><i><font face=3DArial><span style=3D'font-family:Arial'>? (Hint: it's precisely the same as = twenty-four hours in the ICU). </span></font></i></em>But then, I guess we're only = worrying about costs to the extent that they impact your = ED...</span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:maroon'>Finally, the question begs to be asked: if the ICU is a better place for <em><i><font = face=3DArial><span style=3D'font-family:Arial'>this </span></font></i></em>overdose than = the ED, then why don't you just add ten beds to the ICU and send <em><i><font face=3DArial><span style=3D'font-family:Arial'>all = </span></font></i></em>your overdoses there? Cardiacs, strokes, pulmonaries, traumas... = Where's the line? Inpatients? Meaning that if somebody jumps from = the roof, we should cart him to the Unit? Hell, add THIRTY unit beds, = and CLOSE the silly ED. Beats trying to keep track of what an = emergency is this week.</span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:maroon'>It's comforting that if the = opinions of the ICU nurses on the list count for anything, they'd probably take = pride in demonstrating the sort of functionality and flexibility that you = discourage in your Emergency Department. Sigh.</span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:maroon'>Seems about the only thing you = and I can agree on is that this is has nothing to do with trauma. Let's go off-list, or better, retreat to our corners and wait for a more = appropriate thread.</span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span = style=3D'font-size: 10.0pt;font-family:Arial;color:maroon'>Pret</span></font></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal style=3D'margin-bottom:12.0pt'><font size=3D2 = face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'> -----Original = Message-----<br> <b><span style=3D'font-weight:bold'>From:</span></b> Andrew J Bowman [mailto:sumieb@compuserve.com]<br> <b><span style=3D'font-weight:bold'>Sent:</span></b> Tuesday, January = 21, 2003 5:01 PM<br> <b><span style=3D'font-weight:bold'>To:</span></b> = trauma-list@trauma.org<br> <b><span style=3D'font-weight:bold'>Subject:</span></b> Re: = Intrahospital Transfer</span></font></p> </div> <blockquote = style=3D'margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt'> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>Wow, guess I touched a = nerve.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>From one seasoned ER nurse to another I = respect your input. All that is except for the name calling, but since I have = worked in an ER for over 20 years I have been referred to and called much = worse.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>I am always now and have always been the one = to say "Treat the patient" But come on. Sending a patient = from the floor to the ER for care. Sure it says a lot for me and my = staff and very little for the hospital ICU. If the ICU cannot handle = emergencies then why are they wasting their time training to be ready to take care = of emergencies.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>When a patient on the floor codes = and gets resuscitated where do they go??? Yep, = ICU.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>When a patient on the floor throws = a post-op PE and goes into respiratory failure where do they go??? = Yep again, the ICU.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>When a patient on the floor goes from = unstable angina to ST elevation MI where do they go? Yep, the cath lab and = then to the ICU.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>So WHY, WHY, WHY should this patient be = treated any differently???????????? The ICU is wide open, the patient has a POTENTIALLY bad situation form the OD and needs close observation, = frequent reassessments and cardiac monitoring. Hmmmmmmmmmmm, sounds like = ICU in my neck of the woods.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>Plus at my facility the ED is much easier to = escape from than the ICU since we are not a locked unit (neither is our ICU but = a camera watches the patient 24/7 and the monitor tech can alert the staff immediately if the patient who is suicidal decides to elope). So = if they want to escape there are 2 wide open doors to do it from and then right = out to the street.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>Plus you promoted the idea of influx when you = said that the ED is the best place to refer an emergency condition. If = we do that then we will have to decide, does this patient have enough of an "emergency" to go to ER or should she/he just go to = ICU?</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>Inpatients are inpatients, outpatients are outpatients.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>I have spent shifts in my ICU and OR and = floors to know how busy they are and what they are designed to do. = Inpatients who go bad go to ICU, not backwards to the = ER.</span></font></b></strong></p> </div> <div> <p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span = style=3D'font-size: 12.0pt'> </span></font></p> </div> <div> <p class=3DMsoNormal><strong><b><font size=3D2 face=3DTahoma><span = style=3D'font-size: 10.0pt;font-family:Tahoma'>Andrew B</span></font></b></strong></p> </div> </blockquote> </blockquote> </div> </div> </body> </html> ------=_NextPart_000_004F_01C2C251.8978F3A0--
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