Ideal length of stay in the ED

[Ronald Gross]

Rick,

I think your residents need to learn the trick of recognizing when a patient is sick enough to warrant admission - and that sure a shoot doesn't take 4-5 hours.  Hell, if the history and physical exam takes them more than an hour, we have a problem.  BUT just for laughs, lets say that it does....at the end of that hour the resident should know if the patient can go home or not.  And if the resident needs tests to figure that one out, then the patient needs to be admitted.  It is as simple as that in my eyes.

Ron

>>> "Moore, Rick" <Rick.Moore at TriadHospitals.com> 10/15/2007 12:10 PM >>>
Speaking from the point of view of a facility that has a family medicine
residency and an internal medicine hospitalist program. This is what
holds up admission. The resident/hospitalist comes to the ED performs a
complete history and physical, orders labs, diagnostic imaging,
dictates, consults with attending (in case of resident) then and only
then writes orders for admission. Thus creating the 4-5 hour delay they
are supposed to prevent. Obviously this doesn't apply to trauma cases,
but does prolong the admission of medical cases which bottle necks the
ED.
REM 

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Monday, October 15, 2007 11:02 AM
To: trauma-list at trauma.org 
Subject: Re: Ideal length of stay in the ED

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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