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Ideal ED length of stay? (information & communications support)

Mike Smertka medic0947969 at yahoo.com
Sat Oct 13 16:19:54 BST 2007

I wonder how much of this is a billing issue? If I I have a pt in the ED they get a bill for the ED and ED physician, if they then go to surgury, they get a bill from OR/SICU/PACU, and a surgeon. It is a similar issue when "receiving" hospitals get trauma patients. The ED looks at the patient and sends them to a trauma center. In my experience often with no better care than they could have received from EMS.The stories I could tell...
   Here is one that lives in infamy from my previous employer. We are notified of a trauma alert for RU extremity neuro deficit from a community level 3 trauma center. Our hospital dispatches a helicopter, 45 minutes later they arrive in our trauma bay, 6 surgeons, 2 EMs, 3 nurses, and 2 in house medics meet the patient at bedside. The constricting band from the IV placement at the outlying hospital is removed, patient gets miraculously better, and is discharged home. Life on the razor's edge. I don't know for sure, but I will bet my last dollar the pt. still got a bill from the original hospital and physician. 

Howard Berkowitz <hcberkowitz at hotmail.com> wrote:
I wonder how much of these issues -- and I include the cardiac patient for cath or ICU, and now the stroke patient for interventional radiology, not just trauma -- can be addressed by a new generation of healthcare information system. One initial start I have seen impemented allows field requests for a particular inpatient bed; the National Emergency Number Association (NENA), I believe, also has defined message formats for doing so. 

Having an information and communications system, of course, means nothing if it is not used. From what I'm hearing here, an ideal process would require both the ED staff, and staff or individuals of the service best qualified to help the patient, to have personal communicators. We've used alphanumeric pagers, typically two-way for this; we have yet to find a wireless LAN system that is completely reliable in safe in hospitals. 

Let me throw out a possible scenario:

1. Advanced EMS with patient, recognizing emergent trauma, cardiac, or brain event. Simultaneously pages medical control (presumably in ED) and the on-call staff for the second service.

2. Second service determines if the patient should go to them, or requests more information. The ED may requet more information. It is TBD if the subsequent information exchange might need to involve a telephone conversation, possibly three way with EMS, ED, and 2nd service.

3. If 2nd service and ED agree, ED sets up for any minimal services need, second service sets up to receive patient, and EMS is informed.

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