Ideal length of stay in the ED

[Ronald Gross]

OOOPS - this wasn't that "K", it was this K!  

Sorry, Ken!

>>> "Ronald Gross" <Rgross at harthosp.org> 10/15/2007 4:06 PM >>>
Hey Ken,

If you note, I sent a second post laying this on the attendings as well.  In this day and age the residents are working and ordering ADO (at the direction of) Dr. So-andso, becasue the standard of allowing residents to function alone and sans guidance and/or direction has long been abolished.  

As to giving the residents a break, we did - its called the 80 hour work week!

And as to whether it is easier to do what you need to do in the ED, I can't argue with you.  But I have to balance my convenience with the hours and hours of waiting time by patients in the ED who are waiting for that bed that I am holding on to for my convenience, and the LWBS of 5% and up because of that.

Ron



Ronald I. Gross, MD, FACS
Associate Director of Traumatology
Hartford Hospital
Chair, ACS CT Committee on Trauma
80 Seymour Street
Hartford, CT  06102
860-545-4187 Phone
860-545-2006 Fax
rgross at harthosp.org 

>>> nekton75 <nekton75 at yahoo.com> 10/15/2007 3:18 PM >>>
The scenario in most places I've trained plays out as
follows.....25 y/o male, right lower quadrant pain,
good story, good exam, white count....call the
attending (it's now 11pm), wants to get a scan....
Reality is that most surgical residents are more than
keen to admit and operate on patients. The attitude of
waiting to see patients until studies are done comes
from the staff surgeons. Moreover in private practice,
most surgeons covering the ER aren't rolling out of
bed to go examine the patient and then ordering
further testing as indicated. It's either I'm coming
in...get a scan, or get a scan and call me if the
appendix looks hot. Give residents a break! ;-)  From
a more practical standpoint its much easier to work up
a patient in the ED, you have good exam rooms,
supplies are plentiful, access to radiology is
easier....working up belly pain on the floor is not so
efficient. Hmmmm... now where can I get a speculum,
when's transport coming to take this patient back
downstairs to radiology, anyone have any guiac
developer....

K
--- Ronald Gross <Rgross at harthosp.org> wrote:

> 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
> 
> 
> 
> ************************************** See what's
> new at http://www.aol.com 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/ 
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/ 
> 



       
____________________________________________________________________________________
Pinpoint customers who are looking for what you sell. 
http://searchmarketing.yahoo.com/ 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/ 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/