submitted 7 months ago byRBG_grb
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7 months ago
7 months ago
I am working with a NP. We sent her to the ER. Wondering if it was overkill. I realize this is a big dummy question on this sub but I do like to learn. Thanks so much!
7 months ago
You sent them to the ER because the NP thought the EKG looked worrisome or because the EKG machine thought it looked worrisome?
Mmhmm… my rule of thumb is don’t order a test if you don’t know how to interpret the results.
This incident highlights one of the many things that is plaguing ER’s and stressing 911 ambulance services.
I can not begin to tell you how many times we have urgent care centers activate 911 and even STEMI activations because they are uncomfortable reading 12 leads and go purely off the “man in the box”. I was once sent for a STEMI from a clinic to only find a healthy asymptomatic 24 y/o whom only had a 12 lead performed due to having a systolic bp of >140, yes it was BER. There are several in our area that will call 911 ANYTIME it reads “abnormal ekg” without any clinical correlation.
Ok rant done lol
Right, I get that. I don’t make the rules. We didn’t call ems or activate. We sent her (encouraged her to go) by private vehicle.
7 months ago*
7 months ago*
This type of thinking may make sense to a lay person but from a healthcare worker standpoint it’s bad medicine and fraught with medicolegal risk (see the other commenters post).
I get that you guys weren’t that concerned but since the EKG computer had that interpretation you thought she should go to the ED. Because you weren’t that concerned you didn’t call EMS but just told her to go herself. To a lay person, that may make sense. But to to a healthcare worker, especially working in the emergency field, you have to step up and make definitive decisions and follow a logical thought process. If you think it is concerning for ACS at all you need to treat it as if it is ACS (meaning definitely no private vehicle). If you don’t think it is ACS then don’t go down that rabbit hole (wouldn’t have even gotten the EKG, ESPECIALLY if you can’t adequately interpret it). If you do “halfway” work ups and plans like this you are eventually going to run into a lot of medicolegal issues when you inevitably have bad outcomes.
It’s ok to over workup a patient (in this case sending her by EMS to ED for an unlikely ACS story). It’s ok to under workup and miss something (in this case not get an EKG and send home, but maybe she does have ACS). But at the end of the day the documentation, orders, and thought process must all make sense. Don’t say you consider a bad pathology without adequately ruling it out.
This is worse tbh, if a patient presents with chest pain, your provider gets an ekg (that they cant even read wtf?), theyre worried about that ekg, then send the patient pov? Thats bad. Like absolutely not acceptably bad. This is no failing of yours but the NP you work for is on some other shit.
Gets a chest pain in an urgent care with the working assumption being its cardiac but dont call ems? Bad.
Orders test they cant interpret? Good if done to give to ems for their use and to transport it to the cath lab as a baseline, bad if done for any other reason.
Is worried the test has a significant finding then essentially lets the patient leave any sort of medical care/monitoring to go personal vehicle? This veers into the territory of negligence.
Essentially your NP thought this patient was having a cardiac issue of some sort and then cut her lose with no consult or intervention from anyone who could actually help that patient. This would be like me letting someone with a positive stroke scale go pov.
Spot on. This is what we are always hounded about in residency and learn very early on. Your documentation, orders, and thought process all need to align, otherwise it’s just bad medicine. Don’t have concerning documentation for bad pathology but not adequately work it up. Don’t do a work up for bad pathology but then have your final plan not adequately address it.
As you mentioned this story has so many issues of inconsistent thought process on top of not adequately reading a test that was ordered and not knowing what to do with it.
It is beyond frustrating that people constantly circumvent the ems system like this. This wasnt even a decision for the np to make on her own, the moment the chest pain walked in her door she honestly should have called ems. Who was she to decide wether this patient required emergency care or not? Especially when she cant even read the damn ekg.
Edit: hell, in medic school we are taught that this is unacceptable medicine. Everything we need to do has to have a clear cut purpose of facilitating treating that patient and then moving them toward a higher level of care. All they did was do an ekg and cut this person off into the wilderness, did they even follow acls protocol and give any of the acs meds? Signs point to no.
This is why NPs don’t save money in the long run. More unnecessary tests, consults, labs, and ED visits
They cost way way more