Brutal Day

I had a pretty good second shift last night.  Unfortunately it came right after a full day of ACLS training so it made for a loooong day.

I was a lot more prepared this time and felt a lot more comfortable.  Some of the nurses remembered me (for better or worse) and things went pretty smoothly.

A typical shift starts with logging in.  I get onto the computer and LOG IN as a resident.  Then I get my hands free voice paging system and LOG IN as Dr. Polzin.  Of course the stupid thing then LOGS ME IN as URSULA ANDRES (CANCEL!!) or BETTY WHITE or some other nonsense so I stand in the middle of the hallway yelling into my Vocera until it finally recognizes my name.

Next I survey the scene.  I check the waiting room to see how busy we are.  I check how the other patient in the ED are doing - we have a color coding system that lets you know who is being admitted, who is being discharged and who is just sitting and waiting.  Wait times are posted as well so I can check on that.  Anyone who is RED is a new patient.

I determine which RED patient I want to see.  Usually I look at how many times they've come into the ED for the same problem or how crazy they're likely to be.  Of course, I'm not a student anymore, so I can't justify ignoring everyone I don't want to see.

Then I go into the room and introduce myself.  I take a history, do a physical exam and explain to them what's going to happen next.  Then I track down my attending.  I can either call them on Vocera or I can walk around old-school-style until I find them.  Most of them haven't met me yet so this can be a time for more introductions.  I tell them about the patient and tell them what I'm thinking about doing.  They give me feedback and we come up with a plan.

I write the orders, chat with the nurses and then spend the rest of the shift following up on the orders, labs and radiology. I repeat as needed as I pick up more patients.  By the end of this year I should be averaging 1 patient per hour.  It doesn't sound like much, but some patients can be pretty complex and have multiple issues, not to mention needed special exams or procedures during the visit.  I usually carry about 2-3 patients at one time.  Last night I saw 5 patients in 8 hours so I'm halfway there!

Then comes the decision time - are the patients going to be ADMITTED or DISCHARGED?  After discussion with my attending, and consulting with my GUT FEELINGS we make the decision.  If they have to be admitted I have to call the Admitting Medical Officer for Froedtert.  I need to "plead the case" for why I want the patient admitted which can be intimidating, especially now early on when they don't know me or trust me.  Otherwise I send the patient home with some meds or instructions and hope they weren't sicker than I thought.  Then I have to make sure I've documented everything properly and finally I can go home when my work is done.

That's a glimpse into my shift.  There are a lot of other conversations that go on with other physicians, nurses and techs too.  Any questions?