Ideal length of stay in the ED

[William Bromberg]

I gotta tell you, I disagree. If I'm not mistaken the surgeons to whom
you refer already take primary call for "free". The hospital, (probably
in order to get some sort of state financial support) decides to be a
trauma center. This then essentially doubles the amount of call the
surgeons are required to take. Now, you may think that back-up call is
worth nothing but it is two more weekends a month that you can't leave
town, can't have a beer, can't make plans with your family, etc. etc.
The fact that they rarely do anything on backup is not a feature, it's a
bug. At least when you are on primary call you can make a living by
billing patients — the hospital was asking for unpaid
labor/availability over and above the normal, and certainly not what the
docs signed up for when they got privileges initially.

Let me make it clear, all doctors should take call. This does not give
the hospital the right to unilaterally decide to double your call
responsibility AND make sure you don't get remunerated for it. If the
plan had already been in place ( i.e. the doctors started demanding fees
for what they had already been providing), that's different IMO. Try
that same trick with your nurses and see what happens.

Bill Bromberg

>>> "Moore, Rick" <Rick.Moore at TriadHospitals.com> 10/15/2007 12:36 PM
>>>
I don't deny that call is hell, in or out of house. I myself pull 60
hours of call every third weekend as the on-call ED Supervisor and
many
times that means working at least a 12 hour shift once I have been
called. 
When we designated as a level III center, we had to put a general
surgery back up call schedule in place in order to receive our
designation. Since we had to do it the surgeons of course held out for
call pay an knew they would get it. Now a surgeon makes $1000. a day
just to carry a beeper and stay within a 30 minute response radius to
the hospital. Our volume is still somewhat low and the back-up gets
activated an average of once a month.
REM  

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert F. Smith
Sent: Monday, October 15, 2007 11:23 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Ideal length of stay in the ED

Well Ron is in the midst of a stretch of every other night in house on
call and stays till at least 5 the next day. You couldn't pay me
enough
for that.
The Chair of Trauma at Cook County, the young and beautiful Dr.
Roberts,
will be taking two such calls in the next 7 days for free. But yeah,
it
should include that.

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Moore, Rick
Sent: Monday, October 15, 2007 12:14 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Ideal length of stay in the ED

Wouldn't acting "in the patient's best interest" include having
surgeons
that take trauma call without insisting on exorbitant amounts of call
pay or shipping the uninsured or under insured?
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 11:04 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Ideal length of stay in the ED

Another novel concept - acting "in the patient's best interest".

Rob, I think that you and I just might be on to something wonderful!  

LOL

Ron

>>> "Robert F. Smith" <rfsmithmd at comcast.net> 10/15/2007 12:01 PM >>>
IMHO it is essential that ED physicians have admitting privileges.
Otherwise their job is impossible and the ED is a total dumping ground
and they ED docs become slaves to all the other in house services.

Of course people will object strenuously to this but if people can't
act
like adults in the patient's best interest this becomes a viable
solution.

Rob

-----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, October 15, 2007 11:52 AM
To: trauma-list at trauma.org 
Cc: KMATTOX at aol.com 
Subject: Re: Ideal length of stay in the ED

 
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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