That thing would be writing orders without seeing the patient. The doc looks at the CC and perhaps the triage note (although based on some orders, the latter does not seem like it always happens) and then write orders for it before they assess the pt. One case was a 30 something year old male with a CC of upper abd pain. Doctor orders: IV, abdominal labs, urine, cardiac monitor, chest Xray, and troponin. I go in to do my assessment (still before the doc is in there) and it turns out the guy has a hx of GERD and ran out of his PPI.
It has happened in other circumstances too. One time I thought the doc had already been in the room so I carried out the orders including starting an IV (which meant I had to explain why the doc thinks the pt needs an IV even if he hasn't evaluated the pt). While I'm in the middle of lining him, the doc comes in to the room for the first time. I finish up. As I'm leaving, the doc tells him there is nothing we can do for him since he has been seen at our ER multiple times for the same CC (another abd thing). Patient gets upset since he has been stuck for no reason for an IV that was in 5 minutes.
Docs who do this are trying to save time. Since docs are judged on their times (i.e. time it takes them to make a disposition) it makes sense. However, someone has decided to judge nurses based on customer service scores, and putting in IVs for no reason is decidedly bad for PG scores.
Anyone else deal with this?
OK, rant over...for now.
Quote from kaylasmommy
In our ER we have chief complaint driven protocols in which we can order stuff based on the CC on behalf of the doc based on pt presentation. So often things (lab work, line, X-ray, EKG) are done before the doc sees the pt. we can also give certain Meds (ie nitro and Asa to a chest painer or nebs to a sob). If a pt is on the fence (not sure if doc is going to want full work up) we let doc see pt before we do anything. Sometimes the doc beats us to the pt but other times its a huge time saver. I don't really have a problem doing these things because honestly the lab work and X-rays and EKG are data collection that gives the doc a better idea of what's going on.
Also it's a time saver because while you're getting the pt settled in and doing their vitals you are also doing things that you know are going to be ordered anyway thus saving you a second round with the pt.
These are like protocol orders, but I was not aware that was what the OP was talking about.
Eg, pt comes in with severe angina, SOB, etc, standard protocol orders can be in place for diagnostics, which nurse should be moving on. That's been done in emergency for well over 30-50 years--although standardized orders may not have been written. It was more like the nurses worked with the docs and knew what was needed/anticipated, and they just worked together like a machine. The litigiousness of society changed that, so in order to cover butts re: tx and financial reimbursement, protocol Rxs, based on known conditions and algorithms, are to be established.
But no physician should be writing further tx or dx orders beyond that without actually taking the time --and not just a peek through the door--to see the patient.
Today that have all kinds of people that are investigating this kind of thing. There are even doctors that come in feigning to be patients. They evaluate how things are going. So, in one way or another, these docs or pa's that may be doing this kind of thing are going to get kicked in the butt if they continue practicing in the way in which the OP was talking. The pt-spies or some such situation will jump up to bite them and the hospital in the arse in due time.
Last edit by samadams8 on Feb 25, '13