Monday, November 07, 2005

Some good comments on this post.

Remember, I work as a hospitalist as well as in the ER. I am in a position to feel the pain of both sides.

One of the hospitalists commented that he was worried that "things would be missed" in the transition from the ER to the floor, even if the labs were drawn in the ER, if the patient were transferred with things pending.

I think this is a process problem for the hospitalist service, and should not be solved at the expense of the ER.

I proposed a solution. A general policy that the ER would provide "complete" workups while the admitting docs (not just the hospitalists) would be willing to accept some admits, on an exceptional basis, without the complete workup.

Further, what constitutes a "complete" workup would be negotiated. I prefer the term "adequate" workup.

For example. 54 year old man with HTN and DM, presents with new onset of exertional chest pain, relieved in the ambulance with two sublingual nitros. Nonspecific EKG changes, neg cardiac enzymes (15 minute turn-around POS testing) and neg CXR. Fingerstick glucose.

This would be about a 15-30 minute ER workup. Complete with ASA, Lovenox, initiation of beta-blocker, etc.

I don't think anything else would be necessary for the admission consideration. The admitting physician might want a CBC, metabolic panel, lipids, etc., but these don't need to come from the ER.