Pissed off about CP

[Arizonaffcep]

Did you happen to notice if transfer orders had already been written or some protocol to be initiated? Occasionally but not that often, CCU, PCU or tele orders will be written but unfortunately the patient may not get transferred to the floor or unit for a long time and the orders don't get started. The ED orders will continue. There may have been more aggressive orders waiting in the wings. That is what I meant earlier by becoming familiar with what the other units and floors do especiallly when certain protocols may have been initiated in those areas. Serial labs and diagnostics as well as additional meds may be started. A cardiologist will probably be consulted and additional tests or meds will be ordered. What may appear as a slow process to you may be for the reasons of caution with the patient's overall condition.

At UMC, once the patient is admitted, the ED RN's carry out the written orders by whatever service has admitted them, and they get the same (although without the TV in the room) as they would on the floor/ICU/etc.. The only (until the Lasix order came through) med that was ordered was a Heparin infusion.

And, what choices did the patient make if and when he himself was presented with the risks and benefits? The physician may have said something like we can offer you this treatment (could be cath lab) but this, this and that have a great possibility of happening. Or, we can treat you more conservatively with this treatment and monitor. All the information will be laid out and the patient can make an informed decision with the physician about the risks and benefits of each procedure. When patients present with numerous risk factors, it is usually very clearly presented to them as to what can happen with each option.

Good point...hadn't thought about that. As far as that situation is concerned, when we came on shift, he had been there long enough to be "fluffed and buffed" (put into a hospital bed, tucked in, orders taken off and started). So, he had been there at least several hours already, and as the orders were already being carried out, the CCU team had already been down to see him.

[crotchitymedic1986]

Ventmedic wrote:

Everything has to be about race or sex with you. While there are inequalities that do exist in any system since employees like you will be around, some healthcare professionals actually manage to function quite well above the discriminatory factors to provide quality health care

Look at some mortality statistics regarding minorities and the uninsured -- the facts are against you on that one:

http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf

[Arizonaffcep]

Ok...so here's the follow up...he was placed on a hard tele floor, literally across the hall from the cardiac ICU (which is STILL where I think he should have gone...). He was brought up there a couple of hours after I got off shift, and died from the progression of the MI within 16 hours.

[crotchitymedic1986]

Why dont you speak with the Hospital's Risk Manager ? If you fear retribution, just slide an anonymous note under his/her door. It is common for most hospitals to do case reviews on unusual patients, scenarios, or deaths. This would be a good case for the Doctor's QI/QA Committee to look at. Maybe more could have or should have been done, maybe not ?

[VentMedic]

Or, at least find out if this was also the patient's informed decision. A cath lab procedure might have brought death many hours earlier. If patients know this, they at least have a chance to be with their family if they choose the conservative route with being told what their prognosis is with and without the procedure. Did they work him as a code when he died?

There are tough decisions in medicine that must be made by both the physician and the patient. It is not unusual to have patients wait for days, weeks or even months for a surgical procedure if there are other labs or medical conditions that make the procedure risky. Also, if the person is faced with the possibility of spending the rest of their lifetime as a vegetable even if correcting the cardiac condition is possible, is it the best option for the patient?