Monday, July 14, 2008

Serious Inefficiency

Last night was a seriously screwy call night, and I only had 4 patients.

What made it so bad?
1) One of my patients was seriously sick. Big, bad stroke, initially not seen to be so large on the CT scan (which aren't very sensitive for acute ischemia, but are mostly used to rule out hemorrhage); after obtaining MRI/MRA and seeing how big it was, and the occluded carotid that likely caused it, we had to transfer him from the neuro floor to the ICU. This was a lot of work and worry, as I was afraid this guy was going to code on my floor with only a few nurses and me to save him. Fortunately, he's still doing okay.
2) Another patient had the possibility of going to medicine or neurology. In order to determine where she'd go, we obtained a stat study. And then I had to help wheel her to the study, wait with her while the contrast went in, wheel her back to the ER, and wait for the radiologist to give me a prelim report. I couldn't get started on her note because I wasn't sure it would require an H&P-titled note or an Inpatient Note-titled note. This makes a difference in the template used in the computer, and it's not terribly easy to cut and paste between the two.
3) Medication reconciliations are impossible to do when the patient doesn't have a list, doesn't have the meds, and does not have the stuff in the computer. Yet, I have violated the "rules" by not completing it until this morning, and could receive another lecture about "being in noncompliance."
4) I had one patient whom I called "my pager magnet". Literally, every time I'd go into his room, my pager would go off. I cleared out 18 pages about halfway through the night, and had received another 5 more before morning. This doesn't count all the repeat pages from my upper level, the neuro floor, and the ER. I'm really not that surprised that his H&P took over 6 hours to complete, as I never received more than about 5 minutes of consecutive exam time.
5) Doing things on the weekend made all of this much more miserable. I needed STAT carotid and vertebral imaging on my big stroke patient. Unfortunately, he was unable to have a CT Angiogram with contrast dye, which is usually the study of choice on the weekend or at night. I attempted for an hour to get him a STAT carotid ultrasound, but was told that a) radiology doesn't do them on the weekend, vascular does and b) vascular had no idea what the hell radiology was talking about. The ultrasound tech from radiology was actually present while I was doing all this futile calling, and could have run the study in less than 30 minuts.
6) Fortunately, the MRI tech came in from home to run a STAT MRI/MRA for us. I had to be present for this study as well, since the tech was by herself.
7) The rest of my night was mostly spent at the phone: returning pages from my anxious upper-level ("do you have that read yet??? I know you said you'd page when you got it, but you haven't paged in 30 minutes!"), returning pages from radiology, me PAGING the poor radiology resident (who was also new), fielding floor pages, consult pages, pages pages all I saw were pages.

I really miss having a text pager. It would be so much nicer if I could receive a text page with "Mr. Y has arrived on the floor" than have to go through the whole interrupting the patient interview I'm doing to find a phone and call back, not knowing whether the page I'm returning is vitally important or totally banal. The pager shows no mercy.

4 down, 2 more to go. Next call is Thursday, and I didn't realize I was still q4 until yesterday. It was awfully hard to keep going yesterday. Thank goodness I'm done with weekend call and will have two full days off this week.


The MSILF said...

Do you get the day after call off?

Tiny Shrink said...

We get a "post-call day", meaning that after noon, when we leave after our 30 hour shift, we go home and don't come back until the following day. It's less than 24 hours off.