List Archives

Thu Oct 18 21:05:48 BST 2007

Dr Mattox, 

Guiac developer, hah. You're lucky. Our compliance team told us that because the ED is not an accredited lab that we're not allowed to do any tests -- including guiac, UA or urine preg in the ED. DRE with guiac is now a send to lab test.

Bill
>>> nekton75 <nekton75 at yahoo.com> 10/15/2007 3:18 PM >>>
The scenario in most places I've trained plays out as
follows.....25 y/o male, right lower quadrant pain,
good story, good exam, white count....call the
attending (it's now 11pm), wants to get a scan....
Reality is that most surgical residents are more than
keen to admit and operate on patients. The attitude of
waiting to see patients until studies are done comes
from the staff surgeons. Moreover in private practice,
most surgeons covering the ER aren't rolling out of
bed to go examine the patient and then ordering
further testing as indicated. It's either I'm coming
in...get a scan, or get a scan and call me if the
appendix looks hot. Give residents a break! ;-)  From
a more practical standpoint its much easier to work up
a patient in the ED, you have good exam rooms,
supplies are plentiful, access to radiology is
easier....working up belly pain on the floor is not so
efficient. Hmmmm... now where can I get a speculum,
when's transport coming to take this patient back
downstairs to radiology, anyone have any guiac
developer....

K
--- Ronald Gross <Rgross at harthosp.org> wrote:

> WAIT!!!  I have a novel concept!  Never been done
> before!  
> 
> Are y'all ready????
> 
> Why don't we teach the residents to come to the ED,
> take a history, do a physical examination, and admit
> the patient based on all of that??  I think that
> really beats "Call me when the CT is done", and my
> guess is that the patient would be moved out of the
> ED and on to the floor about 4 to 5 hours sooner.
> 
> WOW.  I think I am on to something novel.  We might
> want to do a study or something........
> 
> Y'know, sometimes I really crack myself up!
> 
> My best to all,
> Ron
> 
> >>> <Krin135 at aol.com> 10/15/2007 11:52 AM >>>
> 
> In a message dated 14-Oct-07 10:35:16 Central
> Daylight Time,  KMATTOX at aol.com 
> writes:
> 
> In a  message dated 10/14/2007 9:57:26 A.M. Central
> Daylight Time,   
> andrewj.bowman at gmail.com writes:
> 
> What  then do we do about the  attendings (fill in
> specialty here) who  are
> reluctant to admit a  patient without the complete 
> workup????
> 
> 
> Create a hospital  policy that allows, encourages,
> mandates that the EC  
> staff 
> have the  authority, and supported by the Medical
> Executive Committee to  
> admit  a patient to any hospital in-service where
> the service is slow to  
> evaluate  
> the patient or require that an entire work up occur
> there  prior to going to 
> an 
> in house bed.   
> 
> k
> 
> 
> 
> 
> I'd love it...now just need to convince the med exec
> committee (and the  
> hospitalists) that the hospitalists and attendings
> don't need every jot and  
> tittle done in the ED prior to admission....
>  
> and convince some of the residents at major teaching
> hospitals that they  can 
> finish the work up faster after they have the
> patient in their hands than  
> the smaller hospitals can do prior to transfer...
>  
> ck
> Charles S. Krin, DO FAAFP
> 
> 
> 
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William J. Bromberg, MD, FACS
Chair, EAST Practice Management Guidelines Committee
Savannah Surgical Group
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