A hospitalist describes what's going on at their institution where a surgeon stops seeing their hospitalized patient:
This week, we ( hospitalists) are being asked to take care of post op ortho patients who the ortho guy will not see at all till the discharge day in the hospital. Is this now the new standard of care?
This is one of the worst examples of patient abandonment I can imagine. Surgeons are paid a bundled fee to provide surgical care for a 90 day period on many surgiers. I'm pretty sure CMS would like to hear about this surgeon's policy of not providing their agreed upon service contract with the federal government.
I would never, ever, not in a million years agree to see post operative patients if a surgeon was not also following daily. I am not trained nor experienced enough nor do I have any desire to evaluate and manage post operative surgical sites of care.
Your orthopaedic surgeon is failing to provide the standard of care and if anything bad ever happened surgically they are in deep trouble. Here's what you do. You write a letter to whomever is responsible for implementing that policy. If it is an administrator you tell them you will immediately cease to follow or admit primary orthopaedic problems without daily orthopaedic evaluation. If the surgeon does not want to do it, they should hire, or the hospital should hire a PA or NP on the surgeon's behalf to do post surgical related care.
You have no training, and therefor no responsibility to provide that care for the surgeon. This is an example of gross incompetency on the administrator level if they implemented the policy. If the surgeon is ordering you, you simply refuse to admit their patients or consult on them if they aren't willing to provide 24 hour care for their surgical patients.
You have no training, and therefor no responsibility to provide that care for the surgeon. This is an example of gross incompetency on the administrator level if they implemented the policy. If the surgeon is ordering you, you simply refuse to admit their patients or consult on them if they aren't willing to provide 24 hour care for their surgical patients.
It's time, in the interest of patient care, that you stand up for the patient and yourself, and say no. You will not provide this service as you are not trained to provide this service. This whole situation is just pathetic.
Quick answer: no, it's wrong. Circuitous answer: I think many (if not all) patients, especially those with multiple co-morbid conditions, which seem to be the bulk of patients at my place of employ, need a IM consult to deal with said co-morbidities as the surgeons are having a really crappy time doing so.
ReplyDeleteCase in point: 80 something year old female admitted for hernia repair, history of afib, HTN and a couple of others, is taken off ALL anti-hypertensives pre-op then not restarted post-op. BP sky rockets, rapid response called for hypertensive emergency, patient is transferred to my floor as the residents who responded to the RRT see that said meds have not been restarted. She gets 25mg PO metoprolol on arrival to the floor after some IV labetalol and her BP drops nicely into acceptable range. If and IM doc had been consulting on said patient, odds are pretty darn good that they would have noticed this and the situation would not have developed (at least they figured it out before they transferred her to the Unit to be on IV anti-hypertensives or such).
Not that all surgeons suck, but I get the distinct feeling that if it isn't in their purview (i.e. they can't cut it/remove it/excise it etc.) they don't put a whole lot of thought into it. I see it far too often where the patient is not doing well post-op and finally the surgeons "give up" and call in an IM consult to see what they're missing and viola', the patient turns around and goes home, thanks in part to strategies suggested by IM..
But hey, I'm just a nurse.
So... what does this mean, Happy? I haven't seen too much rounding by orthos/PAs as it is. Everybody is discharged out to home or rehab quickly anyway. It's not like your gonna go in and fix it if a screw pops out. Maybe this just frees ortho and his/her PA to bring surgical biz? You know the execs prefer those who can show them the $.
ReplyDelete-Second career nursing student
If the surgeon is paid a bulk fee for the procedure (and post procedure care), then how can a hospitalist be reimbursed for care related to that case?
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