Monday, July 30, 2007

How NOT to make an ICU transfer

As the newbie resident who has only been working in the hospital for about 2 weeks, if you realize your patient is in deep you-know-what, for chance let's call this an extensive GI-bleed and you decide to do the right thing and transfer that pt. to the ICU for further stabilization and preparation for scoping, this is exactly what NOT to do...

1. Assume that your supervising "Fellow" (4th year resident) is arranging the transfer for you.
2. Ignore frantic pages from the floor nurse who is actually taking care of the patient. Meanwhile, fortunately for you, we proactive nurses who already have an idea how much trouble your patient is in are already taking the initiative to fire off the labs, ekgs, check on blood status, and other things which we know are warranted.
3. Don't mention anything to the Charge RN who is actually responsible for communicating with the receiving floor's charge nurse in order ensure that there is a bed and an ICU-trained nurse able to take the patient.
4. After you've been complaining all day that your orders are taking their sweet time getting taken off (uummm....yeah, that is because we've already pointed out to you *multiple times* that the float secretary we have today is extremely behind despite our intermittent help, so that all-important stool softener order may sit around for awhile and please feel free to call us with urgent orders) set your order book BEHIND 4 other order books with multiple orders. The orders you placed also contain STAT blood transfusions and other extremely necessary, sensible things for this sort of situation.
5. Again, say absolutely nothing about these extremely important orders to anyone. Neglect to notice that it is shift change, secretary is long goooone, and not a soul is sitting at the front desk taking orders off. Somehow manage to make the order book reappear after we've been looking for you and paging you the last 45 minutes and decide to take matters into our own hands.

There a darker side of working at a teaching hospital, and that darker side is called the month of July. This is when we get fresh-faced, friendly, eager-to-please, new residents. I actually really enjoy this turnover, and the collaboration between physicians and nurses at my institution is really excellent. I've found that the learning environment fostered here does promote better care, and overall patients notice and appreciate this as well..however, once July rolls around you can guarantee a few incidents such as these....

Luckily, this is NOT the TV sitcom Scrubs so you don't get the pleasure of having me go all Dr. Perry Cox on your poor, tired resident self. Even if you might benefit from it. (Y'all thought I was going to use a different word here, didn't you?)

Luckily, the patient survived the crisis well and further complications were avoided. Luckily, there was an Oncology-ICU bed and a nurse able to take that patient within 20 minutes of the time I placed the call to the Oncology-ICU Charge Nurse. Luckily, I was able to to talk to the resident face to face and kindly inform him that in the future, the people actually physically doing the work at the patient's bedside need to be informed of pending ICU transfer so proper arrangements can be made, and to please call with stat orders if there is no secretary readily taking off such crucial orders.

When does medical degree = no common sense?

I think maybe he gets it now.


Anonymous Therapist said...

While they do teach many things in medical school, common sense is (sadly) not one of them. They say that the road to hell is paved with good intentions...seems that every now and then a resident manages to illustrate that perfectly.

Jen said...

Ah, the joys of a teaching hospital. :) It brings back so many memories. :)

Cheryl and Greg Morton said...

I would PaY to see you go Dr. Cox on this guy! If another incident comes up and you decide to take that route, I hope you don't mind me taking the front row seat. :]

Vitum Medicinus said...
This comment has been removed by the author.
Vitum Medicinus said...

If by "common sense" you mean the "unwritten intricacies of how not to piss off people in the hospital," no, we are not taught that in medical school.

I'm glad you took the time to take the resident aside and explain where they went wrong. I would sincerely appreciate anybody willing to try and let not me make an ass of myself and piss off a lot of people more than once.

I hope that the resident was receptive of your feedback and not rude. If they were, well, then they don't deserve someone as nice as you to tell them what to do next time.

raecatherine said...

vitum m.-- I don't view it as a personal attempt to piss anyone off, I just chalk it up to the resident's inexperience with a rapidly deteriorating patient and a numbed brain from being post-call. He was perfectly fine with what i had to tell him--but he was so tired, I just hope he remembers!

I think nurses tend to be generally forgiving. We're in this whole quality patient care thing together, so yeah...I think it is important to point out the things that potentially compromise patient safety. In a collaborative way...and then later, you can rant on your blog.

Vixen said...

Yeah...I agree, interns suck! I don't know how they make them look so 'smart' on Grey's Anatomy!