So, at the local hospital, they have a shiny new computerized medical records system which allows nurses to pull up patient charts on the computer and view all the relevant history, meds, allergies, etc and add documentation right there.<\/p>\n
Sounds great, right.<\/p>\n
Well, so did the Titanic.<\/p>\n
Ok, the problem is that now, instead of the old way when I dropped off a patient, where the nurse would walk into the room with me –maybe with a pen and paper or maybe like a really good waitress, just her perfect memory — take my report, help get the patient moved over to the hospital cot, switch over the EKG leads, take vitals and start treatment, now they need to Pull Up The Record.<\/p>\n
Here’s a quick example of the old Stone Age way we did things, and the New Improved way.<\/p>\n
Stone Age Emergency Medicine.<\/b><\/p>\n
We arrive at ER. Go straight into a room with the patient. A nurse and a tech come in with us, the tech helps move the patient, the nurse poises her pen.<\/p>\n
Nurse: What’cha got.<\/p>\n
Medic: This is Bob. He’s 56, and awoke this morning with 8 of 10 crushing chest pain radiating to his jaw and down his left arm. Took two of his own nitro tabs without relief. On our arrival he was pale, cool, sweaty, radial pulse of 92. EKG was sinus rhythm, 12 lead shows elevation in V2,3 and 4, BP 150\/90, lung sounds clear, denies shortness of breath, nausea, or dizziness. Past history of high blood pressure, past MI [Myocardial Infarction, or heart attack] insulin dependent diabetic. Takes [lists meds] allergic to [lists]. We started a 20 gauge IV normal saline in his left hand, gave 325 mg of aspirin, two sublingual nitro, patient had some relief, states pain is\u00a0 now 4 of 10. O2 at 4 liters, here are the bloods we drew. Any questions?<\/p>\n
Nurse: Nope. Sounds good<\/p>\n
Door to treatment time: 30 seconds.<\/p>\n
New and Improved Emergency Medicine<\/b><\/p>\n
Patient into room. Nurse out at computer, tech comes in to help.<\/p>\n
Medic: Ok, this is Bob–<\/p>\n
Tech: I can’t take report.<\/p>\n
M: Ah.<\/p>\n
*moves patient over, not giving report. Goes out to computer where nurse is typing with both<\/i> fingers.*<\/p>\n
Nurse: What’cha got?<\/p>\n
M: 56 year old male–<\/p>\n
N: What’s the name?<\/p>\n
M: Uhm, Robert Lamontaigne. So, he’s 56, woke up with–<\/p>\n
N: How do you spell that?<\/p>\n
M: -a-i-g-n-e. So, woke with 8 of 10 chest pain–<\/p>\n
N: (to screen) Dammit. Do you have his date of birth?<\/p>\n
M: Yeeaaaaaah…hang on… *looks at notes* …May 12, 1956. So, 8 of 10 crushing–<\/p>\n
N: Does he still live at 104 Oak Street?<\/p>\n
M: Yeah. Sure. So two nitro with no relief–<\/p>\n
N: Past Medical history?<\/p>\n
M: Uh..high BP, lemme see…yeah, MI in ’07, and insulin dependent–<\/p>\n
N: Dammit! Is his PCP still Steinberg?<\/p>\n
M: *blinks* Not a clue.<\/p>\n
N: *to patient* Mr Lamontaigne! Do you still have Doctor Steinberg?<\/p>\n
Bob: For my heart I have some Indian guy.<\/p>\n
N: Patel?<\/p>\n
B: Sounds right. The pain is coming back…<\/p>\n
M: Yeah, so, chest pain. Got nitro and aspirin. Here’s his EKG. IV in his–<\/p>\n
N: You guys gave Oxygen?<\/p>\n
M: No. Wait! Yeah. 4 liters. So he was in a sinus rhythm with ST changes in leads–<\/p>\n
N: *sighs* Why won’t this enter? Ok, Meds?<\/p>\n
M: *completely lost train of report, grasping at straws* Uh…aspirin…um… Here *hands med list to nurse* So, he was pale, cool and —<\/p>\n
N: *looking at list* Mr Lamontaigne, what do you take the Prednisone for?<\/p>\n
B: Oh, I stopped that last May. I feel kinda dizzy…<\/p>\n
*Partner signing frantically. Either we have a bad call or she really needs coffee.*<\/p>\n
M: *rips page from notebook, hands over with EKG printout and med list* Yeah, have fun with Bob, here, we have a call…<\/p>\n
N: *muttering to self* These Paramedics can’t keep their reports straight.<\/p>\n
Door to treatment time: Like a month. Dunno. I left while she was slapping the computer and yelling. Bob was looking worse than when I found him.<\/p>\n
God, I love progress!<\/p>\n","protected":false},"excerpt":{"rendered":"
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