WhiteCoat

Archive for November, 2010

Fall Back

Saturday, November 6th, 2010

It is that time of year when most of the country sets its clocks back one hour in order to provide more daylight for itself during working hours.

It is also that time of the year when those who with clipboards who audit hospitals are on heightened alert for those practicing clinicians who dare not make clear their orders during said time change.

You see, it is possible that a patient could be registered at 1:45 AM on November 7, 2010, but that the same patient’s orders could be timed at 1:05 AM on November 7, 2010 and that the patient could be discharged at 1:30 AM on November 7, 2010, which, on paper, appears as if the patient was discharged before the patient arrived.

Because such notations could make the heads of clipboard auditors explode, this trickery must represent a de facto patient safety issue and would require the involved clinician and/or hospital to create an action plan on how to prevent such unsafe practices in the future.

Document carefully, dear friends. Document carefully.

Hospitals in Arizona and Hawaii are lucky enough to have dodged this bullet since those two states do not follow Daylight Savings Time.

Healthcare Update — 11-03-2010

Wednesday, November 3rd, 2010

Because men like getting a Q-Tip shoved up their woo-hoo when they go to the emergency department for nasal congestion. The American Society for Clinical Pathology recommends that men be screened for sexually transmitted diseases in the emergency department. Just what we need – longer waits due to “mission creep.” We screen for tuberculosis, domestic violence, tetanus immunization, and a bunch of other things already. What’s next, mandatory prostate checks? Personally, I think that all medical examiner offices and microbiology labs should be required to screen everyone for sexually transmitted diseases. Walk right in to your local morgue for your free screening, folks. Pathologists want to make the rules, let them deal with the requirements.

Another news story about how emergency department violence is on the rise.

Vaccine exemptions have quadrupled in the San Diego area in the past decade. Is it any surprise that pertussis infections has set a new record in San Diego County this year? Or maybe it is an Al Queda plot. The second link even has an audio file of what whooping cough sounds like. Ten infants have died from the disease statewide. With such a preventable disease, shouldn’t parents of unimmunized children who die from preventable infections suffer some consequences?

They don’t go very well with milk. Methotrexate vials recalled due to contamination with glass flakes.

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Inside the ER, qeustion if more security is needed.” Answer: YES. Outside the “ER,” “qeustion” if more proofreading is needed …

How much should emergency nurses make each year in salary? Divide these numbers by an average of 2000 work hours in a year and the hourly wage isn’t as much as it should be for someone who may be the difference between you walking out of the hospital and you being rolled out of the hospital.

Pennsylvania man wins $3.5 million verdict after physicians misdiagnose brain infection as cancer.

When sharks sense blood in the water, you know what happens … Ohio attorneys battling over spoils from a $13.9 million medical malpractice verdict.

The question is whether she’ll get billed for her own services. On duty emergency department nurse asks colleague to do an EKG on her after having bouts of fatigue and jaw pain. The she gets admitted for several days when the EKG shows that she is having a heart attack.

Drug seeking behavior in emergency department doubles. And if those patients give you low Press Ganey scores for not feeding their habit, your hospital fires you, your group gets rid of you, or your pay gets cut. Maybe the goal is to get providers so fed up that they leave the system and then the government doesn’t have to pay for as many health care services. Boy am I glad I’m a doctor.

Connecticut teens becoming more likely to abuse prescription drugs than to abuse heroin, marijuana, and cocaine. Emergency department visits in the area have increased 60 percent from 2004 to 2007. Wonder who fills out the teen Press Ganey surveys.

The “No Wait” Emergency Department. Has anyone out there implemented this type of program? I’d like to know the mechanics of patient flow. I think it’s great that people see a doctor within 30 minutes. The question is: How long do they spend their time “doing something else than waiting” before they are discharged? My cynical side says that this is just a PR move to increase patient volume. Bigfoot, Santa Claus, and the Loch Ness Monster seem to like the idea, though.

Happy November

Monday, November 1st, 2010

My schedule is starting to wind down to its normal chaos instead of its chaotic chaos.
I’ll sure be glad when tomorrow is over for a lot of reasons.

The sugar level in my kids’ collective bloodstreams will be near normal. It’s great that they enjoyed Halloween. They each came home with a half pillowcase full of candy, dumped it on the floor, and began dealing the “bad” candy for the “good” candy. As in …
“I’ll trade you three Laffy Taffy’s for a Butterfinger.”
“No way, Jose.”
“Three Laffy Taffy’s and an Almond Joy.”
“Blecch. Maybe for a Baby Ruth bar.”
“DEAL!”

The thing that the kids don’t realize is that some types of candy increase the osmotic load in the gastrointestinal tract. As a result: Technicolor diarrhea for Ms. Skittles in the SuperGirl costume.

One of our neighbors has this elaborate display in his front yard each year, so we get all of the traffic jams and strange people hooting and hollering up and down our road until midnight. I wanted to get out the paintball gun with the laser sight, about 11PM, but was able to restrain myself.

In total, we went through 27 bags of candy in about 5 hours. We actually had to start handing out recycled candy toward the end of the allotted time. Guess where those Almond Joy and Laffy Taffys went.

After tomorrow I also won’t have to listen to political ads on the radio, look at political ads on the computer, or have my mailbox filled with flyers about how much the other candidate raised taxes or voted with Obama or align with this political party. Negative ads suck, but supposedly research shows that the negative ads are the only thing that people remember.

Then there’s what to do with all those political yard signs. Duct tape and yard signs could make a pretty cool toy house for the girls. Or a hunting stand. Or target practice. Or ….

It will be interesting to see how functioning of the government changes after the elections.

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