Archives for September 16, 2007

Why I accept a lot of transfers

I’m lucky enough to work at a big community hospital with a lot of resources, and we get a decent number of transfers from smaller surrounding hospitals. The ED doc is stuck taking the call from the sending doc, to both make sure we have coverage for the specialty they say they need, and to ward off the occasional inappropriate transfer / transfer that would be much better served going elsewhere*.

Recently I took a call, the synopsis of which was ‘unstable angina but normal enzymes, some Q waves on the EKG, and pain free: need transfer because we don’t have cardiology’. Unstable angina is often managed by non-cardiologists, but I accepted, rationalizing it’d be an easy transfer anyway, and you never know.

You never know, indeed. When the patient arrived, the EKG with the ‘Q waves’ they did looked like this:


Got a nice quick trip to the cath lab. (For those scratching their heads, this is an acute MI, the machine’s screaming MI in the automated printout, but apparently the doc looking at it didn’t believe it)(the machine is frequently wrong, but you need to look hard at the tracing when it’s saying something you don’t expect).

This will be read as a guy in the Ivory Tower looking down on the little guys in the trenches, and it’s not intended that way. It is why I’m going to accept anything cardiac for a long, long time though…

(* This does not mean I’d commit an EMTALA violation by refusing a transfer, it means sometimes patients are better served elsewhere. For example, while we have a hand surgery call list our joint cannot do re-implantations, so while technically we can handle hand injuries a few patients need transfer to a more appropriate facility).