Which doc in charge of ER holding patients?

MAGIK GIRL · Jan 20, 2004

most of the places that i have worked we charted on the er chart but depending how long there are in the er (ie 2 days or so) you had to do the floors medicine cardex.

the floor docs care for the pts but for emergencies, the er doc is responsible. can you imagine calling a code to the er for a floor pt?:chuckle

Jon's sis · Jan 20, 2004

In our ER, they use separate paperwork for ER notes/actions. We have a 23 hour observation section in the ER where the info gets charted on the med/surg charts, after that it's either to the floor to be continued or d/c.

neneRN, BSN, RN · Jan 21, 2004

We keep on using the ER paperwork as long as they're still in the ER. If it's an ICU admit, then the ER doc will sign the pt over to another ER doc while we're waiting for a bed. Otherwise, we have to call the admitting doc for orders. Like MAGIK said though, in an emergency, an ER doc would jump in rather that trying to find the admitting. (Interestingly, we're not REQUIRED to call the admitting for orders until the patient has been admitted for two hours- likewise, once the admitting doc writes orders, we are not REQUIRED to carry out orders until its been 2 hours since written- with the exception of any STAT orders of course. Which is not to say we won't call the MD or initiate orders if we have time or pt has immediate needs- its just written this way in ER policy to give us a little leeway when considering that we're still taking new ER patients, and thus able to give them priority)

veetach · Jan 21, 2004

We create an inpatient chart when the patient becomes a "hold". We chart graphics, meds on the MAR, etc in the inpatient chart and anything that is by exception in the ER chart... very confusing for new employees.

I wish there were a better way. We are at a disadvantage now because we are the only dept in the hospital that does not chart on our computer system. That is set for change in 2004.

ALL of our hold patients are admitted by an attending other than our ER docs. Our ER docs do not admit anyone.

RNin92 · Jan 21, 2004

Originally posted by neneRN
We keep on using the ER paperwork as long as they're still in the ER. If it's an ICU admit, then the ER doc will sign the pt over to another ER doc while we're waiting for a bed. Otherwise, we have to call the admitting doc for orders. Like MAGIK said though, in an emergency, an ER doc would jump in rather that trying to find the admitting. (Interestingly, we're not REQUIRED to call the admitting for orders until the patient has been admitted for two hours- likewise, once the admitting doc writes orders, we are not REQUIRED to carry out orders until its been 2 hours since written- with the exception of any STAT orders of course. Which is not to say we won't call the MD or initiate orders if we have time or pt has immediate needs- its just written this way in ER policy to give us a little leeway when considering that we're still taking new ER patients, and thus able to give them priority)

We are supposed to switch to the floor charting as soon as the patient is admitted. In our hospital the admission forms...are 14 pages long!!! Can you believe it! No wonder those floor nurses are ticked off when we have admits!

I like how you are not REQUIRED to initiate anything except stats for 2 hours. Our floor nurses are royally pissed off when we don't complete all this social history stuff even with regular admits...let alone holds.

Our docs are completely done with patients once admit orders are written. Everything goes thru the attendings. The ER docs will only step in if the attending calls and asks them to or if it is a code.

I live in a very different world than reality.