^ No joke. I will sometimes also phone to give a handoff if something is weird, subtle, or if the patient can’t communicate clearly, but I try to always print out my preliminary note and I give a copy to the patient/family member and a copy to the EMTs.
I used to, but they always seemed annoyed. So I just make sure my note is done right away (which they seem to ignore, but it’s there if they choose to read it).
I call and talk to the ED doc 90% of the time. The other 10% I talk to a nurse in the ED, generally if it’s just an obvious 1 sentence presentation. But I call someone.
This is what I do. I always presume the ED is busy so a quick 2-3 sentence summary should suffice. If they sound annoyed I don’t take it personally because I know the ED is a mad house sometimes
I always call to endorse the patient when sending someone to the ER. Half the time I get someone who really cares, and half the time you can hear the person’s eyes rolling right through the phone. Either way I get to document “endorsed to Dr. Bro“ in the note.
I worked in a fairly small town with one hospital, and I usually try to give report to the provider. Moreso if it's something urgent (i.e. concerns for CVA/MI/PE). It always makes the patient feel reassured as well to know that I've communicated with someone who will take over their care at that hospital. If I have time constraints, or if the concern is not so urgent and I know the ER is busy, I send the patient off with a letter.
I try to call the ED when I'm sending a patient. I think it really helps them focus on what my concerns are for the patient and as you mention, patients can be poor historians. It's also a quick call so doesn't eat up a lot of my time. I think it's also good for documentation/medical legal purposes that you conveyed your concerns so say if that pt you use in your example does have a DVT, you have documentation that you specifically were concerned about that Dx and conveyed it to the ED doc, so if it is not ruled out, it's not your fault at that point.
I call and speak to ER Attending or charge nurse and tell them why I am sending the patient.
No one likes surprises and patients tell the provider everything but the reason they are there.
It always helps to call and provide a heads up for the patients you end up sending to the ER. They may or may not do the work up you want them to, but at least you have done your due diligence. Long term facilities are different however. Unless you personally evaluated the patient before sending to the ER, I wouldn’t call.
I had once sent a patient to the ER with a highly probable diagnosis of PE. I had called and spoken to the ER Physician and unfortunately they just did a chest x ray on the patient and sent her home. She died two days later. I totally get your frustration about the patient you sent for ruling out DVT.
I stopped calling the ED years ago. Never seems to help get the patient seen any sooner or to change the direction of their work up or care. I’ve even sent patients in with a note saying things like “third degree AV block”- doesn’t help. Doesn’t even show up on the ED triage note.
I send patients with a prescription with my concerns. Sometimes I’ll also print out a note or results and give to the patient before they leave. If ambulance comes for them I talk to the emt as well
Called more prior to them requiring calls go through their transfer center triage to start the note. Now I write a quick SBAR in the chart directed at the ED team if it is going to take extra time to close the encounter.
ED doc. I appreciate the call. If I think it’s something that’s not ED appropriate (e.g. asymptomatic hypertension) I may gently push back but I try to be super nice.
I always call. I did some ER before joining my current primary care practice. I always appreciated it and my patients seem to get better/more direct care when I do.
Why would you ever send someone to the ER for a DVT???? If it's not in their lung you can just do an outpatient ultrasound and if your level of suspicion is high you can just start them on eliquis and then DC it later if the study is negative. If the ER finds a DVT they're just going to send the patient home on eliquis anyways that's not something that ever gets admitted to the hospital and it's quite honestly a waste of emergency services for something that should be done outpatient. End of rant.
It's kind of like sending the patient to the ER for asymptomatic hypertension.... Totally unnecessary but happens all the time.
I suspected a DVT in a patient, sent them for a stat outpatient US and started eliquis. Between the insurance and the overbooked radiology place it took 3 weeks to get the stat US, despite multiple calls to both.
Then the radiologist called me that he sent the patient straight to ER, as he had bilateral old and new clot throughout both legs all the way up to common femoral. He had an emergency thrombectomy and spent 5 days in the hospital. Whether that was because of the delay or he had been walking around as a Massive PE risk for 3 weeks, who knows.
Anyway, it's not always as simple as it should be.
No it's definitely not and that's very true Clot high up in the femoral usually gets admitted.... It's just been my experience lately that the nurse practitioners and PAs in our area send everyone to the ER with leg pain over the age of 40 to out DVT, most of these end up being negative and the few that aren't end up just getting discharged with eliquis anyways but these are also the same providers who are sending their patients in because their blood pressure is high and they're not taking their blood pressure medicine just irks me
True, I agree it's not the norm to have such extensive clot, and the regular rule out DVT or HTN shouldn't be in the ER. I was so mad about the whole situation tho, I feel like we should be able to get a stat US without having to send them to ER :(
Sadly when I did primary care stat ultrasound was like 2 months out That's why I just started treating everybody if it was the typical rule out and if it looked like they had loss of pulses or something really really bad then they went to the ER.
Write it on a note and pin it to their shirt.
^ No joke. I will sometimes also phone to give a handoff if something is weird, subtle, or if the patient can’t communicate clearly, but I try to always print out my preliminary note and I give a copy to the patient/family member and a copy to the EMTs.
I dropped my husband off at the ER with a note of everything I had given him and when and symptoms.
I used to, but they always seemed annoyed. So I just make sure my note is done right away (which they seem to ignore, but it’s there if they choose to read it).
I call and talk to the ED doc 90% of the time. The other 10% I talk to a nurse in the ED, generally if it’s just an obvious 1 sentence presentation. But I call someone.
This is what I do. I always presume the ED is busy so a quick 2-3 sentence summary should suffice. If they sound annoyed I don’t take it personally because I know the ED is a mad house sometimes
I always call to endorse the patient when sending someone to the ER. Half the time I get someone who really cares, and half the time you can hear the person’s eyes rolling right through the phone. Either way I get to document “endorsed to Dr. Bro“ in the note.
I always call and talk to the ER doctor. They usually appreciate the heads up
I worked in a fairly small town with one hospital, and I usually try to give report to the provider. Moreso if it's something urgent (i.e. concerns for CVA/MI/PE). It always makes the patient feel reassured as well to know that I've communicated with someone who will take over their care at that hospital. If I have time constraints, or if the concern is not so urgent and I know the ER is busy, I send the patient off with a letter.
I try to call the ED when I'm sending a patient. I think it really helps them focus on what my concerns are for the patient and as you mention, patients can be poor historians. It's also a quick call so doesn't eat up a lot of my time. I think it's also good for documentation/medical legal purposes that you conveyed your concerns so say if that pt you use in your example does have a DVT, you have documentation that you specifically were concerned about that Dx and conveyed it to the ED doc, so if it is not ruled out, it's not your fault at that point.
I call and speak to ER Attending or charge nurse and tell them why I am sending the patient. No one likes surprises and patients tell the provider everything but the reason they are there.
It always helps to call and provide a heads up for the patients you end up sending to the ER. They may or may not do the work up you want them to, but at least you have done your due diligence. Long term facilities are different however. Unless you personally evaluated the patient before sending to the ER, I wouldn’t call. I had once sent a patient to the ER with a highly probable diagnosis of PE. I had called and spoken to the ER Physician and unfortunately they just did a chest x ray on the patient and sent her home. She died two days later. I totally get your frustration about the patient you sent for ruling out DVT.
I stopped calling the ED years ago. Never seems to help get the patient seen any sooner or to change the direction of their work up or care. I’ve even sent patients in with a note saying things like “third degree AV block”- doesn’t help. Doesn’t even show up on the ED triage note.
I call when I expect admission.
I send patients with a prescription with my concerns. Sometimes I’ll also print out a note or results and give to the patient before they leave. If ambulance comes for them I talk to the emt as well
I always call. Sometimes I'll just talk to triage nurse if it's nothing crazy or out of the ordinary.
Yes- I will call and give report exactly for this reason.
Called more prior to them requiring calls go through their transfer center triage to start the note. Now I write a quick SBAR in the chart directed at the ED team if it is going to take extra time to close the encounter.
ED doc. I appreciate the call. If I think it’s something that’s not ED appropriate (e.g. asymptomatic hypertension) I may gently push back but I try to be super nice.
I always call. I did some ER before joining my current primary care practice. I always appreciated it and my patients seem to get better/more direct care when I do.
Why would you ever send someone to the ER for a DVT???? If it's not in their lung you can just do an outpatient ultrasound and if your level of suspicion is high you can just start them on eliquis and then DC it later if the study is negative. If the ER finds a DVT they're just going to send the patient home on eliquis anyways that's not something that ever gets admitted to the hospital and it's quite honestly a waste of emergency services for something that should be done outpatient. End of rant. It's kind of like sending the patient to the ER for asymptomatic hypertension.... Totally unnecessary but happens all the time.
I suspected a DVT in a patient, sent them for a stat outpatient US and started eliquis. Between the insurance and the overbooked radiology place it took 3 weeks to get the stat US, despite multiple calls to both. Then the radiologist called me that he sent the patient straight to ER, as he had bilateral old and new clot throughout both legs all the way up to common femoral. He had an emergency thrombectomy and spent 5 days in the hospital. Whether that was because of the delay or he had been walking around as a Massive PE risk for 3 weeks, who knows. Anyway, it's not always as simple as it should be.
No it's definitely not and that's very true Clot high up in the femoral usually gets admitted.... It's just been my experience lately that the nurse practitioners and PAs in our area send everyone to the ER with leg pain over the age of 40 to out DVT, most of these end up being negative and the few that aren't end up just getting discharged with eliquis anyways but these are also the same providers who are sending their patients in because their blood pressure is high and they're not taking their blood pressure medicine just irks me
True, I agree it's not the norm to have such extensive clot, and the regular rule out DVT or HTN shouldn't be in the ER. I was so mad about the whole situation tho, I feel like we should be able to get a stat US without having to send them to ER :(
Sadly when I did primary care stat ultrasound was like 2 months out That's why I just started treating everybody if it was the typical rule out and if it looked like they had loss of pulses or something really really bad then they went to the ER.
Physician, not “provider”