One factor in the resistance for soft-call admissions is frankly the paperwork. If the patient gets admitted to me, I have to do a full admit note before I can discharge them. If they already have 2 negative troponins and an outside cardiologist, I still don’t understand why they can’t just get the 3rd trop in the ED and be discharged by the ED. That saves me the effort of doing a whole H&P on a patient, doing an admit note, and then discharging them.

I’m perfectly capable of admitting a patient, writing an admit note, and then discharging them. It just feels like a lot of wasted effort. If I’m planning to discharge them right away, especially if my residents haven’t done their write-ups yet, I’ll try to talk the ED doc into discharging them for me.

My other pet-peeve is the partial work-up. An elderly person set in from her NH with agitation, but a normal exam and normal labs (no leukocytosis), but no UA. Geez. No, you can’t admit her to medicine for “there may be an underlying infection.” Get me a UA, show me the dirty urine, and I’ll stop fussing and take her.

“why would they be still having sx if stents supposed to “fix the problem””
Notice how you still failed to answer the question.

Also notice how you failed to answer any of the questions in my previous comment.

The remainder of your examples don’t make much sense without more information.

“sends pts home w/ dx of gi .. but “well give you sl nitro just in case”
A patient can’t have angina and GI pain together?

“Hears a new 2/6 murmur in pt with fever in noisy er”
So what? It’s bad to hear a new murmur?

”I just dont feel comfortable sending him home” diagnosis.” If you’re so adept at prospectively separating real from imagined cardiac disease, then you should have no problem discharging the patients over the telephone. Do you have any idea what percentage of patients with acute cardiac ischemic events are sent home from the ED?

If you’re going to try to badmouth docs in the ED, at least give some good examples. Maybe you don’t have top notch emergency physicians in your hospital. So far, all your examples show are that you are a backstabbing Monday morning quarterback.

Wanna try answering the questions I asked you and engaging in a rational discussion? Or are you just going to post more vitriol?

Ps- Firefox wants to correct colonoscopies to colostomies; even I’m not that mean.

Using your chest pain example, what would you tell the doc who calls you about such pain?

Assuming the stent were appropriately placed and the patient has good TIMI flow, what would you posit is causing the continuing “same chest pain as before”?

Do you agree or disagree with data showing that half of all ACS cases have normal EKGs during admission?

Would you expect troponin to be “nl” if the patient experienced an acute cardiac event shortly before having a stent placed?

Would you be willing to give verbal discharge orders over the telephone to a nurse to have a patient presenting with “the same chest pain as before” sent home from the ED?

And if a patient with such symptoms called you from home two days after a cath, would you tell them it’s nothing to worry about?