Comments on: How in the world does this happen? http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html Ramblings of an Emergency Physician in Texas Fri, 10 Feb 2012 00:40:33 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Perlmutter & Schuelke, LLP, Austin Attorneys » Medical Malpractice and “Defensive” Medicine http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-19960 Perlmutter & Schuelke, LLP, Austin Attorneys » Medical Malpractice and “Defensive” Medicine Thu, 22 Oct 2009 19:39:27 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-19960 [...] anonymous Texas ER doc has a blog post discussing the medical malpractice story of Christopher Jones. Mr. Jones, 33, arrived at a Los [...] [...] anonymous Texas ER doc has a blog post discussing the medical malpractice story of Christopher Jones. Mr. Jones, 33, arrived at a Los [...]

]]> By: Greg http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-18301 Greg Tue, 16 Jun 2009 17:05:41 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-18301 You can't blame the hospitals, they have to set some form of policy and live by it. You can't blame the doctors, chances are they are working as fast as they can. Doubt anyone wants to be rushed when they get in front of a doc. You can't blame the nurses even the grumpy ones, emergency rooms are swamped because people without money can't be turned down. That being said, I smell lawsuits coming. You can’t blame the hospitals, they have to set some form of policy and live by it.

You can’t blame the doctors, chances are they are working as fast as they can. Doubt anyone wants to be rushed when they get in front of a doc.

You can’t blame the nurses even the grumpy ones, emergency rooms are swamped because people without money can’t be turned down.

That being said, I smell lawsuits coming.

]]> By: GruntDoc » Blog Archive » Olive View ED Triage Death: MI http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-8659 GruntDoc » Blog Archive » Olive View ED Triage Death: MI Thu, 29 Nov 2007 03:39:05 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-8659 [...] background (and some interesting comments from interested parties) see How in the World does this happen? and More on the LA [...] [...] background (and some interesting comments from interested parties) see How in the World does this happen? and More on the LA [...]

]]> By: Ed Bearden http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-8276 Ed Bearden Tue, 06 Nov 2007 16:24:53 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-8276 This is a good example of why a local 24 hr stand alone emergency care facility not connected to a hospital would have been the best solution for him to receive immediate triage. I used to think I would never use one until a fried of mine went to one and was immediately given an evaluation that made a difference. This is a good example of why a local 24 hr stand alone emergency care facility not connected to a hospital would have been the best solution for him to receive immediate triage. I used to think I would never use one until a fried of mine went to one and was immediately given an evaluation that made a difference.

]]> By: GruntDoc » Blog Archive » More on the LA death http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-8262 GruntDoc » Blog Archive » More on the LA death Tue, 06 Nov 2007 09:31:46 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-8262 [...] Pk on Blogger stinks, captchas are bad; incidentally, a response to ERNurseyZagreus Ammon on How in the world does this happen?impactednurse on Blogger stinks, captchas are bad; incidentally, a response to ERNurseyMichelle [...] [...] Pk on Blogger stinks, captchas are bad; incidentally, a response to ERNurseyZagreus Ammon on How in the world does this happen?impactednurse on Blogger stinks, captchas are bad; incidentally, a response to ERNurseyMichelle [...]

]]> By: Zagreus Ammon http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-8254 Zagreus Ammon Tue, 06 Nov 2007 01:52:19 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-8254 This is a great discussion. My response to some of the comments on this post is too long for the comments section, so please see http://executivephysician.blogspot.com/2007/11/missing-heart-attack-in-la-how-much-to.html at my blog. There are bigger picture resource allocations that many commenters rightly bring up. There is also the concern that the sensitivity and specificity of an EKG may not be the answer to preventing this death, which was my original point (and Goatwhacker highlights). I only take issue with Clara, who suggests that administrators are perhaps a lesser form of human. I am a physician first and administrator second. There is insight there and a bridge, but one must be prepared to consider and hear with an open mind. Grief is not the right context to take on a policy and management issues. This is a great discussion. My response to some of the comments on this post is too long for the comments section, so please see http://executivephysician.blogspot.com/2007/11/missing-heart-attack-in-la-how-much-to.html at my blog. There are bigger picture resource allocations that many commenters rightly bring up. There is also the concern that the sensitivity and specificity of an EKG may not be the answer to preventing this death, which was my original point (and Goatwhacker highlights).

I only take issue with Clara, who suggests that administrators are perhaps a lesser form of human. I am a physician first and administrator second. There is insight there and a bridge, but one must be prepared to consider and hear with an open mind. Grief is not the right context to take on a policy and management issues.

]]> By: clara http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-8152 clara Fri, 02 Nov 2007 04:43:32 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-8152 I have a vested interest in these comments, and the patient as well. I have known the pt since he was 5 years old. His mother is my best friend. I am also a nurse (not ER, but county jail). I have pt's (inmates) c/o CP everyday of the week. Mostly its drug seeking. I've NEVER ONCE told them to go wait. I'm not willing to risk my job, or their lives on a reckless decision. We get a lot of MRSA too. We test them all. This pt worked for the studios in Hollywood and had terrific insurance. He went to that hospital because he was scared and it was the nearest facility. The EKG would have been paid for. Zagreus Ammon, you appear to think like a machine. Are you, perhaps an administrator? Bottom line and all, right? In the mean time, I fly to LA tomorrow to help my friend bury her youngest child. He had everything in the world to live for. He had a good job and his mother was so proud of him. I'm ashamed that there are things like this happening in ER's. Here's to all you good (and overworked) ER nurses and doctors. I have a vested interest in these comments, and the patient as well. I have known the pt since he was 5 years old. His mother is my best friend. I am also a nurse (not ER, but county jail). I have pt’s (inmates) c/o CP everyday of the week. Mostly its drug seeking. I’ve NEVER ONCE told them to go wait. I’m not willing to risk my job, or their lives on a reckless decision. We get a lot of MRSA too. We test them all.

This pt worked for the studios in Hollywood and had terrific insurance. He went to that hospital because he was scared and it was the nearest facility. The EKG would have been paid for.

Zagreus Ammon, you appear to think like a machine. Are you, perhaps an administrator? Bottom line and all, right? In the mean time, I fly to LA tomorrow to help my friend bury her youngest child. He had everything in the world to live for. He had a good job and his mother was so proud of him. I’m ashamed that there are things like this happening in ER’s.

Here’s to all you good (and overworked) ER nurses and doctors.

]]> By: ERMurse http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-8151 ERMurse Fri, 02 Nov 2007 03:29:14 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-8151 The only downside of doing the EKG in Triage is when the ED is not staffed with a back-up Triage Nurse and doing an EKG extends the wait of patients in line waiting to be Triaged, many who are very sick. In ED's with the luxury of having open beds its simple, once the complaint is determined to be Chest Pain the patient goes straight back. Those that run full all the time, including their Hall Space, need to have 2 Triage Nurses or a Nurse / Midlevel / MD combo (provided the midlevel or MD is willing to do hands on triage and ekg's) to not only handle the lines that form at Triage but do EKG's and recheck those who are waiting. Some big urban ED's try to do all this with one Nurse which results in a lot of things that should be done not getting done. Others throw in a greeter to help manage the line but they dont to EKG's. And then there is the space issue as Nurse K pointed out. # posted by ERMurse : 11:37 AM The only downside of doing the EKG in Triage is when the ED is not staffed with a back-up Triage Nurse and doing an EKG extends the wait of patients in line waiting to be Triaged, many who are very sick. In ED’s with the luxury of having open beds its simple, once the complaint is determined to be Chest Pain the patient goes straight back. Those that run full all the time, including their Hall Space, need to have 2 Triage Nurses or a Nurse / Midlevel / MD combo (provided the midlevel or MD is willing to do hands on triage and ekg’s) to not only handle the lines that form at Triage but do EKG’s and recheck those who are waiting. Some big urban ED’s try to do all this with one Nurse which results in a lot of things that should be done not getting done. Others throw in a greeter to help manage the line but they dont to EKG’s. And then there is the space issue as Nurse K pointed out.

# posted by ERMurse : 11:37 AM

]]> By: WhiteCoat http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-8148 WhiteCoat Fri, 02 Nov 2007 02:11:50 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-8148 Zagreus Ammon - They're "worthless" tests until one of two things happens: 1. You or your family member go to the ED. Sorry Johnny, you're my son and all, but the chances of you having MRSA are only about 2%, so we'll just stick it out and hope you don't become all septic on us. 2. One of the tests turns up positive. When this happens, everyone with a retrospectoscope jumps in and says how they could have predicted the test to be positive before the test was even ordered. And who's the dummy that keeps ordering all those negative tests, anyway? As soon as you find someone with chest pain willing to reject an EKG because they only have a 1% chance of having a heart attack, let me know. And when you find a lawyer who won't sue because the "laws of probability" weren't in the doc's (or patient's) favor that night, I'd like to meet him. Medicine is a little different when <i>you're</i> the one responsible for someone's life. Zagreus Ammon –
They’re “worthless” tests until one of two things happens:
1. You or your family member go to the ED. Sorry Johnny, you’re my son and all, but the chances of you having MRSA are only about 2%, so we’ll just stick it out and hope you don’t become all septic on us.
2. One of the tests turns up positive. When this happens, everyone with a retrospectoscope jumps in and says how they could have predicted the test to be positive before the test was even ordered. And who’s the dummy that keeps ordering all those negative tests, anyway?
As soon as you find someone with chest pain willing to reject an EKG because they only have a 1% chance of having a heart attack, let me know.
And when you find a lawyer who won’t sue because the “laws of probability” weren’t in the doc’s (or patient’s) favor that night, I’d like to meet him.
Medicine is a little different when you’re the one responsible for someone’s life.

]]> By: jerry http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html/comment-page-1#comment-8146 jerry Fri, 02 Nov 2007 01:45:08 +0000 http://gruntdoc.com/2007/10/how-in-the-world-does-this-happen.html#comment-8146 Time cannot expand. At my ED anyone who complains of pain anywhere between their ear and groin get an EKG at triage because the hsopital promotes us as a "chest pain" center. Other medical problems get ignored at the expense of getting the EKG on the 18 year old with bronchitis. Time cannot expand. At my ED anyone who complains of pain anywhere between their ear and groin get an EKG at triage because the hsopital promotes us as a “chest pain” center.

Other medical problems get ignored at the expense of getting the EKG on the 18 year old with bronchitis.

]]>