Direct admits and "Stat" orders -- if it's that urgent why not call 911?

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Specializes in Utilization Management.

I got a direct admit with active chest pain from the doctor's office.

Patient was told to come directly to the hospital and a bed assignment was given. Patient then went home, packed, had lunch, and then finally came to the hospital -- getting "lost" on the way -- and eventually got to the hospital some FIVE hours after seeing the doc.

Of course the patient had stat orders that we nurses had to implement as fast as humanly possible.

I have to wonder: rather than put the patient at risk or put the receiving staff between a rock and a hard place trying to get hours-old "stat" orders completed, why in heaven's name did the doc not simply call 911????

EMS could've given O2, started an IV, given NTG, put the patient on an EKG monitor, and the patient would have gotten treated stat.

By the way, the patient was a full code and turned out to be having an MI. I worked as fast as possible and the ASA was given, O2 was on, the EKG was done, NTG was given and the IV started and labs drawn within an hour of the patient's arrival.

The patient was shipped over to ICU when the first set of enzymes came back.

However, I feel that this puts the nurses in a precarious position. Are we floor nurses not held to the same standards that the ER nurses would be held to in a case like that?

Isn't the doc being negligent by not calling 911?

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Specializes in Med-Surg.

I'm sure the doc didn't tell the patient to go home and have lunch, etc. However, I agree, if the patient was having active chest pain 911 would have been more appropriate than a direct admit to the floor. With a bad outcome he could be held liable I would think if the family persued with a good lawyer.

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Wow I wish I could say I have never heard that before but I would be lying. I sometimes worry about some of the GP's still practicing out there. I had a patient who had to pull over and call 911 after his Doc sent him POV to the ER. I have also arrived at an MD's office to be told by the secretary the patients in room whatever. Find the patient pale, diaphoretic, moderate dyspnea and complaining of 8/10 CP. All alone in the room, no O2, no ASA, no NTG, no EKG, no IV not even someone to monitor him besides his wife.

Sad really.

Tripps

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Specializes in Travel Nursing, ICU, tele, etc.

OH MY GOD! Was that patient driving? If he were driving, I would call up the AMA and report that Doctor immediately! I HAVE to assume that was not the case...but even so, is that Doctor an idiot? I can't imagine the sh@# that would hit the fan if that happened at my facility. How much more damage do you think that patient's heart incurred because of that stupidity?? On the other hand, perhaps the Doctor did make it clear that the patient needed to go straight to the hospital and that advice was ignored. Maybe the patient's insurance did not cover ambulances? I don't know, there may be mitigating circumstances here. In any case, somebody wasn't thinking! Sorry you had to be the one picking up the pieces and trying to save someone's life in that situation. Way to go!!

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angie, i think it could be proven that everything humanly possible was done to expedite the stat orders, once the pt arrived.

i wouldn't be concerned about that part of it.

however, if i were the md, i'd be concerned that i didn't contact 911, esp if there was a bad outcome.

s/he showed poor judgment in making pt responsible for transport.

leslie

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I've gotten some ridiculous direct admits as well. I've complained, the patient will walk in the door, we don't get a proper report, sometimes the patient is in bad shape. It's the height of absurdity.

I have one particularly grisly story I won't go into, but it was the height of irresponsiblity and break down of communication.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

All I can say is that if I ever have an MI I hope I can go home and make myself lunch first.

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Specializes in Utilization Management.
All I can say is that if I ever have an MI I hope I can go home and make myself lunch first.

Oh, you can, you can. Especially if you're a woman or a diabetic and your pain is atypical.

But the price of that lunch will be cardiac tissue -- and possibly your life.

Which is why anyone with active chest pain (pressure, discomfort) is encouraged to call 911.

Better safe than sorry.

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Specializes in icu, er, transplant, case management, ps.

My PCP office is directly located between the two community hospitals in my town. Several times 911 has been called and responded to cardiac emergencies at his office. I guess my PCP has decided that it is better to be safe then sorry.

Woody:balloons:

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Isn't the doc being negligent by not calling 911?

As every human transaction involves negotiation and the frailties of communication, maybe not. Maybe the doc suggested and the pt refused. The devil's in the details of the phone conversation between the pt and doc. I wouldn't second-guess that one.

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Specializes in Spinal Cord injuries, Emergency+EMS.
I'm sure the doc didn't tell the patient to go home and have lunch, etc. However, I agree, if the patient was having active chest pain 911 would have been more appropriate than a direct admit to the floor. With a bad outcome he could be held liable I would think if the family persued with a good lawyer.

calling for an emergent transport should have been a no-brainer forthe doc ... calling 911 however is different matter, the patient has been seen and assessed by a health professional , who should have commenced initial treatment ... the Doc is the one who is in the doo-doo here not the nursing staff at the hospital as they acted in line with the medicla care plan for the patient , when the patient finally arrived and acted on the findings...

as for where the patient is placed that should depend on the ECG that the Doc did when he /she made the decision to admit and logically the patient needs to be admitted to a Cardiac care area if they are having an MI, this is something which the 'failing' socialised monolith called the NHS gets right ... not everything comes through the ED and the assessment units if correctly set up provide very good assessment and initial management as well as turning round those patients who have no clinical need for an acute hospital bed in a clinically approrpaite time frame...

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Specializes in Telemetry & Obs.

I can't stand direct admits....seems something *always* goes wrong with them.

Once had a patient come directly from the MD's office with nary an order..or so I thought. I asked the patient if the doctor gave her some papers to give to us?? Ummm, yeah..but the secretary wrote directions to the hospital on the back of them and her friend who drove to the hospital took them HOME WITH HER!! By now its after hours and can't get a single person at the doc's office. HMPH!!

Had to call the friend to bring back the orders!?!

I think the least they could do is fax over orders with time for us to go over them so they can get clarified if needed. Oh, and a phone call would be nice.

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