RE: Another Hospital Question

[Guest guest]

Yeah, our hospital has a 48h rule, too, I think -- but rarely enforced.Some of us live 30 minutes away and are on phone call at night for the hospitalist, so end up calling in a lot of sleeping meds or adjustment in IVFs, etc.

If we had to drive 60 miles round trip to just sign off an order, we'd probably all throw a fit.They have gone electronic in our hospital and I actually have the ability to sign on through a secure web connection and digitally sign off an order in the system.

Locke, MD

 

My hospital was just told by the state of California to have all phone orders signed within 48 hrs.  Nursing Homes accomplish this by fax, but our hospital is intending to require the attending physician who rounds to sign off the covering physician's phone order the next day. 

That seems to me to be worse than faxing, since the attending physician cannot confirm that the transcribed order was written accurately without calling the on-call physician.  How do others do it at their hospitals?

 

The hospital here was hit after an audit revealed several admissions to doctors that were not available on the night the admission was made to them.  Since the ER failed to notify the covering physician, all charges for these admissions were disallowed and a statement of fraud was filed with the attorney general’s office.  After this happened, this policy was quickly rescinded and the patient cannot be admitted to a physician who has not seen the patient personally or at least talked to the ER physician and accepted the patient.  We had similar issues where patients were sent to the floor that either shouldn’t have been admitted at all or were admitted to our small rural hospital and we did not have the ability to care for the final diagnosis.  There was a huge go round between the medical staff and the administration.  I had an issue with them as

well.  My malpractice carrier claimed that my policy covered me if I was covering unassigned admits in the capacity of a family physician.  This same hospital administration decided to have 2 different call schedules.  One for unassigned adults which included both the family doctors and the internal medicine doctors.  The peds call schedule included both the family doctors and the pediatricians.  However after this change the pediatricians dropped from full privileges to courtesy staff only.  What this meant was that family physicians were covering twice the call because of the separate adult schedule.  The powers that be refused to understand that by having 2 schedules the malpractice carriers felt that the family doctors were covering twice the call thereby doubling their risk.  I refused to take call on different nights for pediatric and adult medicine and I was called before the medical board for refusing to

take call or provide adequate malpractice coverage for my inpatient duties.  The malpractice carrier wrote 4 different letters explaining that I was covered for pediatrics provided the admission came as a result of my family medicine call duties and not pediatric specific call.  We went round and round for over a year about this.  Then the same administration decided to close the OB department and gave me 11 days advance notice to transfer my 38 active OB patients to other doctors at other hospitals.  When this happened I made alternate arrangements for admissions and ceased my association with the rural hospital.  The point of this story is that the hospital administration will implement any policy that these supposed efficiency experts deemed good for the hospital even if said policy is stupid and poorly thought out from a staff and patient standpoint.

 

Beth Sullivan, DO

Ridgeway Family Practice

Commerce, GA  30529

 

From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Skaggs

Sent: Wednesday, April 28, 2010 3:26 PMTo: practiceimprovement 1 Subject: [Practiceimprovemen t1] admissions thru ER question

 

 

Hi All,

Have a question for those who admit to hospital.  Our hospital has hired a consultant firm to improve patient satisfaction with our ER " service " .   They have decided that the best way to make people happy is to shorten the ER stay as much as possible, so they are now wanting to implement a policy where the ER doc decides if the patient will be admitted, and then sends the patient to a floor bed, and THEN the doctor to whom the ER has admitted the patient is notified.

 

They have started doing this, with silly results: 27 year old with a cough, but no fever is " diagnosed " with " pneumonia " , and sent to the floor with no CXR and no CBC.  I come order both and find no infiltrate and WBC count is 6.....  but the ER length of stay was only 12 minutes, administration is thrilled.   But now I have to discharge the patient, who is understandably confused.

 

 

My question: has anyone else seen this sort of crazy strategy?  I have never seen anyplace where ER docs are allowed to force anybody to admit any patient, much less all patients. -- Annie Skaggs

-- Annie SkaggsLexington, KY

[Guest guest]

The ordering physician has to sign off on

their own orders….Dr. Roy was always getting notice from the San Ramon hospital

that he wasn’t signing his orders fast enough….and the hospital faxed them to

our office.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of postrio

Sent: Wednesday, April 28, 2010

8:19 PM

To:

Subject:

Another Hospital Question

My hospital was just told by the state of California to have all

phone orders signed within 48 hrs. Nursing Homes accomplish this by

fax, but our hospital is intending to require the attending physician who

rounds to sign off the covering physician's phone order the next day.

That seems to me to be worse than faxing, since the attending physician

cannot confirm that the transcribed order was written accurately without

calling the on-call physician. How do others do it at their hospitals?

The hospital here was hit after an

audit revealed several admissions to doctors that were not available on the

night the admission was made to them. Since the ER failed to notify the

covering physician, all charges for these admissions were disallowed and a

statement of fraud was filed with the attorney general’s office. After

this happened, this policy was quickly rescinded and the patient cannot be

admitted to a physician who has not seen the patient personally or at least

talked to the ER physician and accepted the patient. We had similar

issues where patients were sent to the floor that either shouldn’t have been

admitted at all or were admitted to our small rural hospital and we did not

have the ability to care for the final diagnosis. There was a huge go

round between the medical staff and the administration. I had an issue

with them as well. My malpractice carrier claimed that my policy

covered me if I was covering unassigned admits in the capacity of a family

physician. This same hospital administration decided to have 2

different call schedules. One for unassigned adults which included both

the family doctors and the internal medicine doctors. The peds call

schedule included both the family doctors and the pediatricians. However

after this change the pediatricians dropped from full privileges to courtesy

staff only. What this meant was that family physicians were covering

twice the call because of the separate adult schedule. The powers that

be refused to understand that by having 2 schedules the malpractice carriers

felt that the family doctors were covering twice the call thereby doubling

their risk. I refused to take call on different nights for pediatric

and adult medicine and I was called before the medical board for refusing to

take call or provide adequate malpractice coverage for my inpatient

duties. The malpractice carrier wrote 4 different letters explaining

that I was covered for pediatrics provided the admission came as a result of

my family medicine call duties and not pediatric specific call. We went

round and round for over a year about this. Then the same

administration decided to close the OB department and gave me 11 days advance

notice to transfer my 38 active OB patients

to other doctors at other hospitals. When this happened I made

alternate arrangements for admissions and ceased my association with the

rural hospital. The point of this story is that the hospital

administration will implement any policy that these supposed efficiency

experts deemed good for the hospital even if said policy is stupid and poorly

thought out from a staff and patient standpoint.

Beth

Sullivan, DO

Ridgeway

Family Practice

Commerce, GA

30529

From: Practiceimprovement

1yahoogroups (DOT) com [mailto:Practiceimprovement

1yahoogroups (DOT) com] On Behalf Of

Skaggs

Sent: Wednesday, April 28, 2010

3:26 PM

To: practiceimprovement 1

Subject: [Practiceimprovemen t1]

admissions thru ER question

Hi All,

Have a question for those who admit to hospital. Our hospital

has hired a consultant firm to improve patient satisfaction with our ER

" service " . They have decided that the best way to make

people happy is to shorten the ER stay as much as possible, so they are now

wanting to implement a policy where the ER doc decides if the patient will be

admitted, and then sends the patient to a floor bed, and THEN the doctor to

whom the ER has admitted the patient is notified.

They have started doing this, with silly results: 27 year old with a

cough, but no fever is " diagnosed " with " pneumonia " , and

sent to the floor with no CXR and no CBC. I come order both and find no

infiltrate and WBC count is 6..... but the ER length of stay was only

12 minutes, administration is thrilled. But now I have to

discharge the patient, who is understandably confused.

My question: has anyone else seen this sort of crazy strategy?

I have never seen anyplace where ER docs are allowed to force anybody to

admit any patient, much less all patients.

--

Annie Skaggs

--

Annie Skaggs

Lexington, KY

[Guest guest]

I can’t remember if ours are 24 hours or 48 hours.  But I

will sign my covering physicians orders if they seemed appropriate to me.  But

not if I don’t agree with them.  And I hope she does the same for me. 

Because if they aren’t seeing the patient, they really aren’t going

to remember to sign orders and especially if there is no other reason to come

in.

I will occasionally sign certain consultants orders too.  Not

all of our consultants are able to come in every day for a stable patient.  If

I agree with the order and would have ordered it myself had I been called, I

will sign it.

The only time I have been able to do faxed orders is if the

chart is now at a different hospital (our sister hospital) because the patient

got transferred and the original is not going to be coming back.  Then they fax

the papers up for signature.

We are ½ computerized.  Orders not in the computer.  That would

be best.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Pratt

Sent: Wednesday, April 28, 2010 11:57 PM

To:

Subject: RE: Another Hospital Question

The

ordering physician has to sign off on their own orders….Dr. Roy was

always getting notice from the San Ramon hospital that he wasn’t signing

his orders fast enough….and the hospital faxed them to our office.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From:

[mailto: ] On Behalf Of postrio

Sent: Wednesday, April 28, 2010 8:19 PM

To:

Subject: Another Hospital Question

My

hospital was just told by the state of California to have all phone orders

signed within 48 hrs. Nursing Homes accomplish this by fax, but our

hospital is intending to require the attending physician who rounds to sign

off the covering physician's phone order the next day.

That seems to me to be worse than faxing, since the attending physician

cannot confirm that the transcribed order was written accurately without

calling the on-call physician. How do others do it at their hospitals?

The hospital

here was hit after an audit revealed several admissions to doctors that were

not available on the night the admission was made to them. Since the ER

failed to notify the covering physician, all charges for these admissions

were disallowed and a statement of fraud was filed with the attorney general’s

office. After this happened, this policy was quickly rescinded and the

patient cannot be admitted to a physician who has not seen the patient

personally or at least talked to the ER physician and accepted the

patient. We had similar issues where patients were sent to the floor

that either shouldn’t have been admitted at all or were admitted to our

small rural hospital and we did not have the ability to care for the final

diagnosis. There was a huge go round between the medical staff and the

administration. I had an issue with them as well. My malpractice

carrier claimed that my policy covered me if I was covering unassigned admits

in the capacity of a family physician. This same hospital

administration decided to have 2 different call schedules. One for

unassigned adults which included both the family doctors and the internal

medicine doctors. The peds call schedule included both the family

doctors and the pediatricians. However after this change the

pediatricians dropped from full privileges to courtesy staff only. What

this meant was that family physicians were covering twice the call because of

the separate adult schedule. The powers that be refused to understand

that by having 2 schedules the malpractice carriers felt that the family doctors

were covering twice the call thereby doubling their risk. I refused to

take call on different nights for pediatric and adult medicine and I was

called before the medical board for refusing to take call or provide adequate

malpractice coverage for my inpatient duties. The malpractice carrier

wrote 4 different letters explaining that I was covered for pediatrics

provided the admission came as a result of my family medicine call duties and

not pediatric specific call. We went round and round for over a year

about this. Then the same administration decided to close the OB

department and gave me 11 days advance notice to transfer my 38 active OB

patients to other doctors at other hospitals. When this happened I made

alternate arrangements for admissions and ceased my association with the

rural hospital. The point of this story is that the hospital

administration will implement any policy that these supposed efficiency

experts deemed good for the hospital even if said policy is stupid and poorly

thought out from a staff and patient standpoint.

Beth

Sullivan, DO

Ridgeway

Family Practice

Commerce,

GA 30529

From: Practiceimprovement

1yahoogroups (DOT) com [mailto:Practiceimprovement

1yahoogroups (DOT) com] On Behalf Of Skaggs

Sent: Wednesday, April 28, 2010 3:26 PM

To: practiceimprovement 1

Subject: [Practiceimprovemen t1] admissions thru ER question

Hi All,

Have a question for those who admit to hospital. Our

hospital has hired a consultant firm to improve patient satisfaction with our

ER " service " . They have decided that the best way to

make people happy is to shorten the ER stay as much as possible, so they are

now wanting to implement a policy where the ER doc decides if the patient

will be admitted, and then sends the patient to a floor bed, and THEN the

doctor to whom the ER has admitted the patient is notified.

They have started doing this, with silly results: 27 year

old with a cough, but no fever is " diagnosed " with

" pneumonia " , and sent to the floor with no CXR and no CBC. I

come order both and find no infiltrate and WBC count is 6..... but the

ER length of stay was only 12 minutes, administration is

thrilled. But now I have to discharge the patient, who is

understandably confused.

My question: has anyone else seen this sort of crazy

strategy? I have never seen anyplace where ER docs are allowed to force

anybody to admit any patient, much less all patients.

--

Annie Skaggs

--

Annie Skaggs

Lexington, KY

[Guest guest]

Why would the attending (I am assuming admitting physician) need

to sign off on a covering physician’s orders unless this is a case of attending

over residents?  I have never been asked to sign off on orders given by a

covering physician.  If this is an admitting/covering issue what happens if the

admitting doctor is going to be gone longer than 48 hours?

Beth Sullivan, DO

Ridgeway Family Practice

Commerce, GA  30529

From:

[mailto: ] On Behalf Of postrio

Sent: Wednesday, April 28, 2010 11:19 PM

To:

Subject: Another Hospital Question

My hospital was just told by the state of California to

have all phone orders signed within 48 hrs. Nursing Homes accomplish

this by fax, but our hospital is intending to require the attending physician

who rounds to sign off the covering physician's phone order the next

day.

That seems to me to be worse than faxing, since the attending physician cannot

confirm that the transcribed order was written accurately without calling the

on-call physician. How do others do it at their hospitals?

The hospital

here was hit after an audit revealed several admissions to doctors that were

not available on the night the admission was made to them. Since the ER

failed to notify the covering physician, all charges for these admissions

were disallowed and a statement of fraud was filed with the attorney

general’s office. After this happened, this policy was quickly rescinded

and the patient cannot be admitted to a physician who has not seen the

patient personally or at least talked to the ER physician and accepted the

patient. We had similar issues where patients were sent to the floor

that either shouldn’t have been admitted at all or were admitted to our small

rural hospital and we did not have the ability to care for the final

diagnosis. There was a huge go round between the medical staff and the

administration. I had an issue with them as well. My malpractice

carrier claimed that my policy covered me if I was covering unassigned admits

in the capacity of a family physician. This same hospital

administration decided to have 2 different call schedules. One for

unassigned adults which included both the family doctors and the internal

medicine doctors. The peds call schedule included both the family

doctors and the pediatricians. However after this change the

pediatricians dropped from full privileges to courtesy staff only. What

this meant was that family physicians were covering twice the call because of

the separate adult schedule. The powers that be refused to understand

that by having 2 schedules the malpractice carriers felt that the family

doctors were covering twice the call thereby doubling their risk. I

refused to take call on different nights for pediatric and adult medicine and

I was called before the medical board for refusing to take call or provide

adequate malpractice coverage for my inpatient duties. The malpractice

carrier wrote 4 different letters explaining that I was covered for

pediatrics provided the admission came as a result of my family medicine call

duties and not pediatric specific call. We went round and round for

over a year about this. Then the same administration decided to close

the OB department and gave me 11 days advance notice to transfer my 38 active

OB patients to other doctors at other hospitals. When this happened I

made alternate arrangements for admissions and ceased my association with the

rural hospital. The point of this story is that the hospital

administration will implement any policy that these supposed efficiency

experts deemed good for the hospital even if said policy is stupid and poorly

thought out from a staff and patient standpoint.

Beth

Sullivan, DO

Ridgeway

Family Practice

Commerce,

GA 30529

From: Practiceimprovement

1yahoogroups (DOT) com [mailto:Practiceimprovement

1yahoogroups (DOT) com] On Behalf Of Skaggs

Sent: Wednesday, April 28, 2010 3:26 PM

To: practiceimprovement 1

Subject: [Practiceimprovemen t1] admissions thru ER question

Hi All,

Have a question for those who admit to hospital. Our

hospital has hired a consultant firm to improve patient satisfaction with our

ER " service " . They have decided that the best way to

make people happy is to shorten the ER stay as much as possible, so they are

now wanting to implement a policy where the ER doc decides if the patient

will be admitted, and then sends the patient to a floor bed, and THEN the

doctor to whom the ER has admitted the patient is notified.

They have started doing this, with silly results: 27 year

old with a cough, but no fever is " diagnosed " with

" pneumonia " , and sent to the floor with no CXR and no CBC. I

come order both and find no infiltrate and WBC count is 6..... but the

ER length of stay was only 12 minutes, administration is thrilled.

But now I have to discharge the patient, who is understandably confused.

My question: has anyone else seen this sort of crazy

strategy? I have never seen anyplace where ER docs are allowed to force

anybody to admit any patient, much less all patients.

--

Annie Skaggs

--

Annie Skaggs

Lexington, KY

[Guest guest]

That’s exactly why the hospital has asked us to sign each

other’s orders if we are comfortable with them because otherwise the hospital

is in violation.  Restraint orders have to be signed within the hour so the ER

doctors have agreed to sign off on those for us as we don’t have hospitalists

or house doctors.  It’s cooperation, not hierarchy

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ]

On Behalf Of Beth Sullivan, DO

Sent: Thursday, April 29, 2010 7:16 AM

To:

Subject: RE: Another Hospital Question

Why would the attending (I am assuming

admitting physician) need to sign off on a covering physician’s orders unless

this is a case of attending over residents? I have never been asked to

sign off on orders given by a covering physician. If this is an

admitting/covering issue what happens if the admitting doctor is going to be

gone longer than 48 hours?

Beth Sullivan, DO

Ridgeway Family Practice

Commerce, GA 30529

From:

[mailto: ]

On Behalf Of postrio

Sent: Wednesday, April 28, 2010 11:19 PM

To:

Subject: Another Hospital Question

My

hospital was just told by the state of California to have all phone orders

signed within 48 hrs. Nursing Homes accomplish this by fax, but our

hospital is intending to require the attending physician who rounds to sign

off the covering physician's phone order the next day.

That seems to me to be worse than faxing, since the attending physician

cannot confirm that the transcribed order was written accurately without

calling the on-call physician. How do others do it at their hospitals?

The hospital

here was hit after an audit revealed several admissions to doctors that were

not available on the night the admission was made to them. Since the ER

failed to notify the covering physician, all charges for these admissions

were disallowed and a statement of fraud was filed with the attorney

general’s office. After this happened, this policy was quickly

rescinded and the patient cannot be admitted to a physician who has not seen

the patient personally or at least talked to the ER physician and accepted

the patient. We had similar issues where patients were sent to the

floor that either shouldn’t have been admitted at all or were admitted to our

small rural hospital and we did not have the ability to care for the final

diagnosis. There was a huge go round between the medical staff and the

administration. I had an issue with them as well. My malpractice

carrier claimed that my policy covered me if I was covering unassigned admits

in the capacity of a family physician. This same hospital

administration decided to have 2 different call schedules. One for

unassigned adults which included both the family doctors and the internal

medicine doctors. The peds call schedule included both the family

doctors and the pediatricians. However after this change the

pediatricians dropped from full privileges to courtesy staff only. What

this meant was that family physicians were covering twice the call because of

the separate adult schedule. The powers that be refused to understand

that by having 2 schedules the malpractice carriers felt that the family doctors

were covering twice the call thereby doubling their risk. I refused to

take call on different nights for pediatric and adult medicine and I was

called before the medical board for refusing to take call or provide adequate

malpractice coverage for my inpatient duties. The malpractice carrier

wrote 4 different letters explaining that I was covered for pediatrics

provided the admission came as a result of my family medicine call duties and

not pediatric specific call. We went round and round for over a year

about this. Then the same administration decided to close the OB

department and gave me 11 days advance notice to transfer my 38 active OB

patients to other doctors at other hospitals. When this happened I made

alternate arrangements for admissions and ceased my association with the

rural hospital. The point of this story is that the hospital

administration will implement any policy that these supposed efficiency

experts deemed good for the hospital even if said policy is stupid and poorly

thought out from a staff and patient standpoint.

Beth

Sullivan, DO

Ridgeway

Family Practice

Commerce,

GA 30529

From: Practiceimprovement

1yahoogroups (DOT) com [mailto:Practiceimprovement

1yahoogroups (DOT) com] On Behalf Of Skaggs

Sent: Wednesday, April 28, 2010 3:26 PM

To: practiceimprovement 1

Subject: [Practiceimprovemen t1] admissions thru ER question

Hi All,

Have a question for those who admit to hospital. Our

hospital has hired a consultant firm to improve patient satisfaction with our

ER " service " . They have decided that the best way to

make people happy is to shorten the ER stay as much as possible, so they are

now wanting to implement a policy where the ER doc decides if the patient

will be admitted, and then sends the patient to a floor bed, and THEN the

doctor to whom the ER has admitted the patient is notified.

They have started doing this, with silly results: 27 year

old with a cough, but no fever is " diagnosed " with

" pneumonia " , and sent to the floor with no CXR and no CBC. I

come order both and find no infiltrate and WBC count is 6..... but the

ER length of stay was only 12 minutes, administration is

thrilled. But now I have to discharge the patient, who is

understandably confused.

My question: has anyone else seen this sort of crazy

strategy? I have never seen anyplace where ER docs are allowed to force

anybody to admit any patient, much less all patients.

--

Annie Skaggs

--

Annie Skaggs

Lexington, KY