Recent content by southerndoc

Totally agree. We have 2-3 in our ED (140,000 patients/year) and have an ED pharmacy residency (2 per year). Valuable resource. They respond to all our stroke, trauma, medical, and STEMI alerts. Can easily pull/draw up meds to allow the nurses to focus on starting IVs and such. Validating...

Concur with @gyngyn. You really need legal counsel to advise you. Answering a question wrongly on a medical staff or medical board application can have career ending consequences. Being denied licensure because you lied on an application has way more weight than an employer terminating you...

It's within our system. We are approaching hospitals outside our system to get similar agreements.

You reassess them, and if they're worse, then you repeat head CT. You don't just say "oh 6 hours" and ignore them. If it worsens to a point that they need surgery, then you transfer. BIG1's by definition are extremely small bleeds and rarely - if ever - worsen.

My general philosophy is never to be too early nor too late to adopt something. This is middle of the road now and should be adopted. Our experience with >200 patients has had no bad outcome.

We don't admit ours. We observe them in the ED and then discharge home. No reason to admit. Unlikely for a patient to get a bed in 6 hours anyhow, and it's really a waste to admit them when they're perfectly stable to go home.

This is what some facilities don't want to deal with. Have a hip fracture that your ortho isn't comfortable handling (why I don't know), well let's try to send it to the ER instead of the patient waiting 24 hours and going directly from the sending ER to pre-op. We've started accepting...

It's there. It's been validated. Here's a primer: The Brain Injury Guidelines: Can we avoid talking to neurosurgeons? - First10EM

@Apollyon ED doesn't always have capacity. If we have more patients than beds, we are not obligated to accept a transfer to the ED. If that were the case, tertiary care facilities would be accepting transfers from inability to deny them which would saturate the ED even more and place patients...

As @pkwraith said, the only answers are "yes," "we don't have capability," or "we don't have capacity" if you request transfer. If you call for advice then you aren't formally requesting a transfer. It's all in how you word it. "I have a patient with orbital cellulitis and would like to talk...

Haven't heard that name in a long time!

Why would they do that when they could offer lower wages and force docs to stay with them with non-competes? You and I understand the way to make a doc not leave -- by using a carrot instead of a stick. Administrators want to use the stick so they can keep the carrot for themselves.

You have to arrange for formal transfer.

No, doubtful they can enforce it until the litigation is over. Of course hospitals view it as "good for docs" because it's good for the hospitals. They don't want a cardiologist leaving a hospital and going across town taking all of his/her patients with him/her. Good for docs is really just...

Read that some business groups are already suing. Even if upheld, probably will be tied up in courts for a few years.