Ideal length of stay in the ED
Ronald Gross
Rgross at harthosp.org
Mon Oct 15 20:57:43 BST 2007
"IMHO if you don't want to be on call and have your nights, weekends and
holidays interrupted then be a dermatologist."
Oh God NO - that means that you would have to TOUCH a patient. Be a radiologist - just kidding, Sal! ;-0
>>> "Moore, Rick" <Rick.Moore at TriadHospitals.com> 10/15/2007 3:17 PM >>>
To a degree I agree with you. It can be an inconvenience to be on
back-up call. I don't agree that it prevents you from having a life on
that weekend. I was on call last weekend and I managed to work my
part-time job as a National Registry skills examiner at our NR test site
(although they were aware that at anytime I may have to close down my
station and leave) on Saturday. On Sunday I managed to work in the yard,
go shopping with my wife and barbeque chicken for the family dinner. You
are correct that the facility gets some state funding for being a
designated trauma center, but it doesn't even cover our uncompensated
trauma care. The main reason we and many other hospitals in Texas are
designated is that trauma designation is tied to Medicaid
disproportionate share funding. No trauma designation no dispro. They
are already discussing tying designation in with hospital licensure in
case dispro goes away. So most facilities in this state do at least
designate as a level IV. At my facility primary call is for free because
we do not currently separate trauma and medical call, but many
facilities do and quite a few of them pay all of the trauma surgeons to
be on "trauma call". One facility that I am aware of is paying over $1M
per year in call pay to the trauma surgical specialists for both primary
and back-up trauma call.
As far as nurses on call, I are one, and so is every other nurse
supervisor or administrator here and we all take call for free, it's
part of the job description. Just like to perform surgery on the sick
and injured is part of the job description of the surgeon. We do have
some units that routinely have a nurse on call and that nurse makes the
whopping sum of $1.00 per hour for period of time on call. Granted if
called in they make at least their regular hourly rate and many times an
overtime rate, but that doesn't come close to what a surgeon will bill
for a couple hours of patient care.
Ironically the very surgeons that now demand back-up call pay, initially
volunteered to take call and help with oversight of the trauma program
so the facility would qualify for designation then they occasionally
begin to snivel and threaten to walk if more money is not put on the
table.
IMHO if you don't want to be on call and have your nights, weekends and
holidays interrupted then be a dermatologist.
REM
-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
Sent: Monday, October 15, 2007 12:49 PM
To: Trauma & Critical Care mailing list
Subject: RE: Ideal length of stay in the ED
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 & 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 & 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 & 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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