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Whole-body CT

John Leslie johnleslie48 at gmail.com
Tue Jan 31 10:56:36 GMT 2012


I guess the question of making money whilst awaiting transport depends on where you practice.  Certainly where I work it would be regarded as saving resources to avoid unnecessary CT prior to transfer. 

John Leslie

0412528851

Sent from my iPad

On Jan 31, 2012, at 21:42, Sanjay Gupta <sanjaygupta99_91 at yahoo.com> wrote:

> Recently my practice location has changed from a major trauma center to a "referring" hospital.  I do not think that the physicians in the referring hospitals ever think of money when they order the CT scans.  The two reasons they do that are:  the time it takes for the helicopter or land transport to get in to pick up the patient and secondly ignorance.  But the concept of making money for the hospital by harming a patient probably never crosses anyone's mind.  
>  
> Sanjay Gupta
> 
> 
> ________________________________
> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
> To: 'Trauma-List [TRAUMA.ORG]' <trauma-list at trauma.org> 
> Sent: Monday, January 30, 2012 11:49 PM
> Subject: RE: Whole-body CT
> 
> Norman,
> We also ask that the patients be stabilized and sent without imaging.  Sadly, however, imaging is a very good way for our referring hospitals to make money on the patients that they send to us so that we can take the morbidity/mortality hits, while they keep their numbers pristine and their books in the black.  No matter how much we ask, the outcome is always the same.  I guess it is the "low lying fruit" concept...........
> Ron
> 
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
> Sent: Monday, January 30, 2012 11:38 PM
> To: Trauma-List [TRAUMA.ORG]
> Subject: RE: Whole-body CT
> 
> Currently we do NOT request assessment using CT before transport from an
> outlying hospital. This just delays the needed transport. If the
> referring physician believes that the patients meets either anatomic or
> physiologic triage, we say to send the patient immediately.  Since we do
> not use Mechanism of Iinjury only for destination protocols, this would
> be a physician to physician discussion. If the patient needs to be in a
> trauma center we do not request further workup using CT or anything else
> 
> Norman
> 
> Norman McSwain MD, FACS
> Professor of Surgery, Tulane University
> Trauma director, Spirit of Charity Trauma Center, ILH
> 504 988 5111
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Krin135 at aol.com
> Sent: Monday, January 30, 2012 8:48 PM
> To: trauma-list at trauma.org
> Subject: Re: Whole-body CT
> 
> Pret:
> 
> At least as late as 2005, there was a problem with certain receiving
> programs where PGIII docs were the initial point of contact, and *EVEN*
> in the face of quoting Mattox, McSwain, Bromberg et  al, and the latest
> (then  the 7th, IIRC) edition of ATLS, the residents were insisting on
> having full work ups before accepting patients for transfer.....and then
> proceeded to repeat all  the tests when the patient arrived....to the
> point where I occasionally had to  contact the surgical
> attending....several of whom I had served with during  residency...to
> get the patient on the road in a reasonable amount of time.
> 
> I understand that Dr. Wigle has solved at least part of the  problem....
> 
> Oh, and as a FP doc, I qualified as an ATLS instructor along the way, so
> not all FPs are/were high turnover moving targets. 
> 
> I have maintained for years that it would help if the ACS/COT, the ACEP
> and  the AAFP would co-ordinate things better....The Comprehensive
> Advanced Life  Support Course started by the Minnesota Academy of Family
> Physicians and the  Minn. College of Surgeons back in the 1990s was an
> attempt to reduce the 'merit  badge courses' from four or five (ACLS,
> ATLS, PALS/APLS and ALSO, along with  special packages on burns and
> chemical injuries) by combining all of the  anatomy, physio, pathophysio
> and pharm sections, and emphasizing the team  work (Ideally, rural
> facilities would send a doc, a couple of nurses and a  couple of
> paramedics as a team to go through the course together) needed in
> smaller facilities.
> 
> I don't see where CALS has had much penetration outside of the North
> Central Tier.
> 
> ck
> 
> 
> In a message dated 01/30/12 14:52:59 Central Standard Time,
> pbjorn at emh.org
> writes:
> 
> Honestly, I don't think ATLS deserves much credit OR blame for  the
> over-use of CT's in rural systems.  The "Transfer to Definitive  Care"
> lecture is short and soft-edged -- and follows several hours  of
> slideshows and skills stations which feature CT's as a common
> diagnostic modality.  Moreover, the ATLS certification rate in many
> rural systems is far from ideal: courses are rare and expensive and
> distant, and providers (often moonlighting family practitioners or
> mid-levels or
> locums) are a high-turnover moving target.
> 
> The College  has produced a "Rural Trauma Team Development Course,"
> which does an  excellent job of examining various diagnostic yields in
> the context of  inevitable transfer, and wisely brings nurses and medics
> and other staff  into the conversation; but in its most recent iteration
> it is  discouragingly expensive to disseminate.  (We're exploring  our
> options; but jeez, they went from FREE to fifty bucks a  head,
> practically overnight.)
> 
> And so, regular outreach and published  guidelines may be our best hope
> of modifying behaviors.  One can  hope.
> 
> Pret
> 
> 
> 
> 
> 
> -----Original Message-----
> From:  trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On  Behalf Of Doc Holiday
> Sent: Sunday, January 29, 2012 5:05 PM
> To: .Trauma  List
> Subject: RE: Whole-body CT
> 
> 
> From: pbjorn at emh.org
>> ...  EMS Trauma Advisory Committee is preparing this guideline
> (attached,  currently in draft) for addition to our other online advice
> to trauma  system providers.  Comments or suggestions welcome.
> 
> --> Good  ol' ATLS. Nice.                  
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