Play Nice in the ED: Why Hospitalists and ED Docs Should Be Friends

I do a lot of work as a hospitalist, and have noted a fair amount of antagonism amongst my colleagues towards the ED.  There seems to be a lot of bickering between ED docs and hospitalists as to WHO should take responsibility for patient care. More specifically, if a patient has been admitted to a hospitalist, but remains in the Emergency Department, which physician is now responsible for that patient’s care?

A few rules:

Patient care comes first.

We are all busy, and we are all good, caring physicians.

If a patient is still in the ED, and a crises occurs, the ED MD needs to be responsible.  If I have seen a patient in the ED, then I should be called. However, if a patient is in crises, shouldn’t the nurse notify the ED physician AND the hospitalist?  Of course!  To notify me a patient is getting “worse” when I haven’t had time to assess the patient is nuts.  But it happens all the time.  Common sense must be employed:  DO WHAT IS BEST FOR THE PATIENT!

Now, what about the patients that are not in crises, but about whomthe nurse has questions?  First, I hate it when nurses call me and ask me if Mr. Prinzmetal should be on telemetry (or ask me to designate a level of admission, say observation or ICU) when I haven’t even seen the patient.  The ED physician should have a good enough sense of the patient to designate where (ICU/floor/telemetry) the patient should go. By all means, if I disagree I will change that designation.  So, please don’t call me with THAT question and waste more of my time (and then wonder why I haven’t seen the admissions that have been called to me.)

Now, as to other questions like potassium replacement, sure, call me.  But, please, please, please do NOT call me with major management questions before I have seen the patient.  I hate it when the ED doc calls me to ask if they should start heparin or nitroglycerin drips on cardiac patients.  You have seen the patient, and made the decision that they have an acute coronary syndrome.  You don’t need my blessing to act accordingly.

When the patient gets to the floor, they are my responsibility. Period.  I am watching over most of the patients in the hospital, as we are consulted on most orthopedic patients, and a fair amount of the general surgery patients.  I just ask that ED docs watch over the patients that are physically in the ED.

ED physicians, if you are busy, it means by extension, I am busy. We need to realize that the ED impacts the entire function of the hospital, and directly effects the work flow of hospitalists.

ED docs: here is my pledge to you:

  • I will say thank you every time you save my butt.  I know how many times you have put in lines and run CORs for me when I am crushingly busy.
  • I realize that for every patient I see, you see three.
  • I know that your job is challenging, and sometimes thankless.  I appreciate it everytime you are able to divert the bottom feeders.
  • I will be thankful for the work ups you do.
  • I will bring you candy my next shift.

This post is in response to “Lost in Transition” regarding handoffs at the Moving Meat Blog.  Thank you, Shadowfax and Whitecoat for the dialogue!  See:  http://allbleedingstops.blogspot.com/2008/11/lost-in-transition.html  and http://whitecoatrants.wordpress.com/

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