List Archives

Sun Oct 14 13:56:10 BST 2007

Chuck,

I couldn't agree with you more!

Not to worry about getting old, though - when it comes to practicing medicine/surgery, my wife calls me a dinosaur.  Problem is I can't remember why!  ;-)

Take care,
Ron

>>> Charles J Havel Jr MD FACEP <chavel3752 at embarqmail.com> 10/14/2007 8:36 AM >>>

>From the ED side of things, I cannot for the life of me understand why ED physicians want to keep patients any longer than necessary, trauma patients or, for that matter, any patients.  Any ED physician functioning as sole physician in a small hospital (been there, done that) should be able to run through primary and secondary surveys with the accompanying critical interventions in minutes, not hours.  In the larger, level 2 or 1 trauma center with the luxury of having an entire team available, academic or not (been there, done that too), the same applies.  The unstable patient likely needs to go to the OR/angio/wherever.  The stable patient needs to go upstairs for definitive care or home with good followup. 

Of note, there is I believe a disturbing trend in emergency medicine toward 'completing the workup' and perhaps this may explain some of the tendency to keep patients in the ED for hours.  When I trained in the 'good old days' (some of you will perhaps remember Charlie Aprahamian who ran trauma and Joe Darin who was my chief), I developed a number of guiding principles to my practice of emergency medicine, two of which could be summarized as follows: 1) Patients don't belong in the emergency department, rather home/the OR/the floor/ICU, stated in other terms, the only happy ED is an empty ED; 2) It is a hospital up there (the floor/ICU, etc.) - it's actually possible to order tests and take care of patients there.  Nowadays, the excuses of concern for litigation or patient satisfaction (as if patients are happy with 5 hour or more ED stays) result in longer and longer ED courses for a large number of patients.  With the increasing concern for overcrowding in the ED, it would seem a reasonable approach to do everything possible to move patients through more quickly (in an appropriate fashion). 

Enough of my rant - I must be getting old . . . 

Chuck Havel
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Ideal length of stay in the ED