How many did I swee in the first seven hours of my 12 hour night shift (that's a lot of CPT medical coding) a while back? That would be 10 new patients. In seven hours. What is a hospitalist? You become a machine. An Autopilot. Putting your medical residency to the test. A residency you can't get anywhere except in physician level training. Thousands of data points getting interpreted in a constant stream of multitasking. Labs, xrays, records, families, EMR comparison and cross reference, docs, nurses. All of it being absorbed as I feverishly write my hospital admission orders and do my dictations. So you want to know what a hospitalist does on a busy night? Well, it starts by diverting my pager so only urgent pages or outside calls get through. Sorry folks. Some nights I'm too busy to take 15 pages for a sleeping pill or constipation at 11 pm. Or that midnight call from the roving chart police asking to change the observation stay to a full admit at the moment the clock strikes midnight. The convenience of me being there is not always a good reason to call me. It can wait until the morning.
Here's a little sampling of the first seven hours on my night shift a while back.
- Consult for hypertension in a post surgical
- Consult for alcohol withdrawal and unexplained hypotension causes in a post surgical
- Evaluate a post-op knee for medical issues
- Old guy with weakness and really bad chronic lung disease. Right ventricular failure. Afib. A medical mess.
- An old 72 year old guy with hypoglycemia and a really low potassium as well as 10+ chronic advanced medical conditions, on chronic anticoagulation. Including CAD, DM, CHF, AFib, CKD, COPD. The Vetrad in training
- A critically ill 91 year old woman on ventilator support. Hypotensive. Full code.
- An 89 year old woman with Parkinson's that became agitated. The question is why?
- A 50 year old dude on dialysis with pancreatitis. The question is why? 10th admission for various complications of illness this year.
- A young lady with a painful and swollen jaw.
- Nice old lady falls and breaks her hip. She has three or four non urgent medical problems.
So there you have it. One example of how I spent the first part of my night shift. A busy night by all accounts. And certainly not the norm. On average, I see about 5 - 5/12 encounters per night shift. But for every night where I do two admits, I get nights like this where I do 10 or more. My record in a 12 hour shift at Happy's Hospital was 14 admissions and consults.
It's a good thing that's a record because if that was the norm, I would be long gone searching out greener pasteurs.
Congrats on getting through a tough shift.
ReplyDeleteQuestion: How much of your time and energy during that shift was spent doing medically necessary stuff? We get so accustomed to doing things and asking questions and documenting unnecessary stuff just to placate the CPT gods, or the administrators. If all you had to do was what your medical training and experience required, how much free time would that have freed up? Speaking as a surgeon, the wasted time factor is probably 60% in the office and on the wards, and half that in the OR- my hospital requires incredible amounts of redundant documentation for just about any procedure. Back in the old days, when a kid was brought into a pediatrician with sore ears, the doc could look in the ears, write a Rx for ampicillin, and the entire note might be: "BOM, Rx Amp." 60 seconds. Everyone is happy, and on to the next patient. Oh, for the good old days.
Sorry I missed your previous post on this topic. I agree completely- it's only a matter of what the factor is that we could all increase our productivity if freed from the process. I do wonder why we as a profession don't shout this out from the rooftops. Doubling the number of problems we solve per hour would halve the cost per problem, and I agree that that would be a realistic goal. For that we would have to eliminate the rent-seekers from our profession.
ReplyDeletehow about nurses calls, the obscure and absurd ones in the middle of the night. How do you handle that?
ReplyDeleteI think that this is a great idea, sending out a letter to the nursing heads, informing them of what are appropriate calls and what aren't. Some of them have very serious attitude problems, and unfortunately happen to be charge nurses. This is a serious problem in our hospital. Appropriateness of nursing is a huge problem at our institution. So much so, that Hospitalists have quit, and this had a large contributing factor to it. I am unclear what to do. The phone calls are nonsensical at times 4:00 a.m. potassium of 3.5. Unreal at times. It is not fun being a Hospitalist at our hospital. It is miserable, in large part due to Nursing, who, as it seems like, wishes to function autonomously. Our director is not stepping up to help us out either.
ReplyDelete