August 25th, 2011 by Shadowfax in Research, True Stories
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Well, this is satisfying. Over the years, in our ER we have mirrored the nationwide trend and have significantly increased the utilization of CT scans across the board. The reasons are manifold. Some cite malpractice risks, and indeed in our large group we have had one lawsuit for a pediatric head injury and another for a missed appendicitis which probably did contribute. But, in my opinion, there have been many other drivers of the increased use. For one, CTs have gotten way, way better over the last 15 years, which quite simply has made them a better diagnostic tool. They’ve also gotten way faster. As the facilities have invested in CT scanners, they have increased their capacity and increased their staffing, so the barriers to their use have rapidly diminished. I am so old that I remember when ordering a CT involved calling a radiologist and getting their approval! No more of that, I can tell you.
But a couple of years ago, we really started paying attention (perhaps belatedly) to Read more »
*This blog post was originally published at Movin' Meat*
May 9th, 2011 by Edwin Leap, M.D. in Opinion, True Stories
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Years ago I had a conversation with a surgeon at our facility. He was unhappy that a seriously injured trauma patient came to our facility after a MVC. ‘These patients shouldn’t come here Ed, they should go to a trauma center!’
Fair enough; we aren’t a trauma center. Not a Level I, not a Level II or III; not even a level 0.5! But we are the only hospital in a large rural county, and the closest, largest facility for portions of a few other counties nearby. The nearest hospital with neurosurgery and thoracic surgery is at least 30 minutes further away.
The problem is, torn blood vessels, crushed spleens, collapsed lungs, swollen brains don’t look at the clock, and cars aren’t designed to wreck only near trauma centers, any more than assailants shoot and stab people only within proximity of appropriate care. (It rather defeats the purpose of attempted murder, you know. )
Recently, my partner had the same conversation with the same surgeon. The patient had been shot twice and was hypotensive. ‘These patients shouldn’t come here!’ We understand, the conditions may not be ideal and trauma is, to be quite honest, fraught with medical and legal peril. Read more »
*This blog post was originally published at edwinleap.com*
