Friday, January 06, 2012

welcome to the ER money pit

Can I ask a question? Why is it that when someone comes from urgent care, another hospital, clinic, another ER and has already had lab tests, EKGs, etc., they have to be done all over again? This even happens if the place they come from is part of the same corporation and the labs are on the computer.

Apparently we don't believe THAT OTHER HOSPITAL OR WHOEVER. They have deficient equipment that is probably giving the wrong results. So we better do this shit all over again JUST TO BE SURE.

Another question: Why does someone transferring from another hospital to this hospital have to be seen in the emergency room? They have been worked up at the other hospital. Often they are coming for tests unavailable at the other hospital. Our docs would say that the tests they come for would make a difference in where they are put in the hospital. My question:
So lets say, on the million to one off chance that a completely different diagnosis is found than the one that was suspected on presentation to our ER,why can't the tests be done inpatient and if need be, transfer them to the proper floor? The patient will be more comfortable in an inpatient bed, the ER won't have to use up that bed for a patient that should have been a DIRECT ADMIT. Say it with me boys and girls, D-I-R-E-C-T A-D-M-I-T.

One last question: When did it become the job of the ER to diagnose disease? I ask this because of the increasing use of things like MRIs and CT angios. MRIs have become commonplace in the ER. Mostly we are doing head MRIs. Someone will come in with a neuro symptom. THEIR CT HEAD IS NORMAL. You have ruled out head bleed, stroke, gigantic tumor. Then for some reason,
an MRI is ordered. Shouldn't the procedure be that if you
you have RULED OUT emergent conditions a) it can be done outpatient b) if you are that concerned admit them.

Another common test: CT heart angio. An MI has been ruled out intially in ER by EKG, lab tests. This is not an emergent situation. Another example of if you are that concerned admit them, otherwise do it outpatient. It has got to the point where if your 4th cousin twice removed on you mothers side had high blood pressure, off to CT angio you go. I have NEVER seen anybody rushed to the CV lab or surgery from the results of a CT angio. In fact, the vast majority are normal.

Oh by the way, if you happen to come after 5 pm, CT angio is closed and our sophisticated technology will not be used in your case.

This is the kind of ridiculous shit that goes on in hospitals every day. Thousands of dollars in medical costs are run up unnecessarily. The bottom line on all of the above is one thing: M-O-N-E-Y.


Nurse K said...

The only thing I'd say about MRIs is that head CTs don't show stroke for 16 hours is it, so you need an MRI if you really think someone is currently/actively having a stroke, and the symptoms themselves are not obvious enough in and of themselves or they have some other problem like cancer that may have metastasized to the brain.

But your average "I have a headache" MRI or a young person with dizziness x 1 day MRI or something is just annoying off the charts.

Meghan said...

I also don't mind repeating K+ because it;s so susceptible to hemolyzation and the treatment would be so bad for someone without hyperkalemia (or hypo, i suppose, but it's always hyper isn't it)

Mark p.s.2 said...

Playing devil advocate as to why double checking, I saw this story. A second set of eyes cuts errors at HCMC