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ER covering deliveries/neonatal resuscitations

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  • Avatar snowcanyon 
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    The hospital wants the EM docs (employed) to cover neonatal resuscitations. I think this is insane. Has anyone faced this?

    #198256 Reply
    Liked by Zaphod
    hatton1 hatton1 
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    This is wrong.

    #198260 Reply
    MPMD MPMD 
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    Hard no.

    I knew a doc once who worked at a reasonably well-resourced shop that had this policy. “It’s rare, it never happens.” Etc.

    Middle of the night his happy arse is on L+D (he didn’t even know where that was) trying to tube an apneic neonate. There was basically no supplies, no bag, light on the laryngoscope not working etc etc. Nurses have not idea where anything is. Finally he finagles the tube in with someone holding flashlight over his shoulder, helps stabilize the poor kid and ship them out to University. Pediatrician on call is 20 min away and shows up well after the action. OB throws up hands and claims to have no idea how to do anything with a neonate.

    Next morning he wakes up to a flurry of emails… blaming him. Then when he tried to be proactive and arrange a jump bag for neonatal resus for the ED docs room (scopes, tubes, bags, etc) the L+D charge RN got mad at him for stepping on her turf. Not even kidding.

    Hard. No.

    #198264 Reply
    wonka31 wonka31 
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    Agreed, unless this is a small rural hospital and this is a once in a lifetime type scenario. If this is a medium to large size hospital with resources, better options are available.

    #198265 Reply
    Liked by E5797
    Avatar jhwkr542 
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    While you’re doing that, the NICU docs can cover any traumas that come in.

    The White Coat Investor The White Coat Investor 
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    The hospital wants the EM docs (employed) to cover neonatal resuscitations. I think this is insane. Has anyone faced this?

    Click to expand…

    We told them no. We might have blamed our malpractice carrier. Try that.

    Site/Forum Owner, Emergency Physician, Blogger, and author of The White Coat Investor: A Doctor's Guide to Personal Finance and Investing
    Helping Those Who Wear The White Coat Get A "Fair Shake" on Wall Street since 2011

    #198271 Reply
    Jaqen Haghar, MD Jaqen Haghar, MD 
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    You take all the risk, and hospital gets to save money….  um, no.

    Avatar snowcanyon 
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    As noted before, we are employed, unfortunately, so we are under the hospital’s medmal carrier.

    I agree it’s insane. We are “rural” but not that rural in that there is major university hospital and a peds hospital within a thirty minute drive. We have 42 neonatal resuscitations a year, and we are single coverage at night. We do have telenicu, but I’m not really sure what they can do. It sounds like a nightmare.

    Peds is refusing to do it, refusing to come in at all, and they won’t hire NNPs because money.

    The director thinks this is a grand plan to kiss up to admin, so I think this will happen. The other docs are sheeple and will just fall in line. I work in an area where there are docs clawing to work, and not many jobs.

    I think the question is- do I quit over this? Is this the hill to die on?

     

    #198274 Reply
    Liked by Vagabond MD
    CordMcNally CordMcNally 
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    The director thinks this is a grand plan to kiss up to admin

    Click to expand…

    Sounds like a great way for admin to expect more from the ED group since they’re such “team players”. 42 is quite a few resuscitations. That’s enough to have someone else cover them. It will certainly take away from the ED patients that are actually under your care.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #198276 Reply
    Lordosis Lordosis 
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    It comes down to your comfort level with this. NRP is not that hard but it is frightening when you have a bad baby. I never found that adult codes transfer well to newborns but I’m sure I had less experience with it then a seasoned ER doc. Admin will never understand why a doc who had not done something in 10 years since training wouldn’t be able to just jump in.

    I thought you were moving anyways?

    “Never let your sense of morals prevent you from doing what is right.”

    #198281 Reply
    Avatar snowcanyon 
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    The director thinks this is a grand plan to kiss up to admin

    Click to expand…

    Sounds like a great way for admin to expect more from the ED group since they’re such “team players”. 42 is quite a few resuscitations. That’s enough to have someone else cover them. It will certainly take away from the ED patients that are actually under your care.

    Click to expand…

    I agree. We will get two more hours of coverage a day. I think that’s a bad trade. It seems like it’s going to happen. I have more Peds experience than anyone else in the group, and I do not want to play.

    I’m not sure whether to wait until the inevitable disaster changes the policy, or quit to avoid potentially being the doc involved in said disaster.

    #198282 Reply
    Avatar Anne 
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    Status: Physician
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    As noted before, we are employed, unfortunately, so we are under the hospital’s medmal carrier.

    I agree it’s insane. We are “rural” but not that rural in that there is major university hospital and a peds hospital within a thirty minute drive. We have 42 neonatal resuscitations a year, and we are single coverage at night. We do have telenicu, but I’m not really sure what they can do. It sounds like a nightmare.

    Peds is refusing to do it, refusing to come in at all, and they won’t hire NNPs because money.

    The director thinks this is a grand plan to kiss up to admin, so I think this will happen. The other docs are sheeple and will just fall in line. I work in an area where there are docs clawing to work, and not many jobs.

    I think the question is- do I quit over this? Is this the hill to die on?

     

    Click to expand…

    If I recall from previous posts you are looking to pivot to something else anyway, right?  And are in a good position to be able to do so?

    If you loved the rest of your job and everything that came with it, that would be one thing.  But if you are looking for a career shift, I would take this as a sign that it’s time.  It sounds like a bad situation. I can only imagine the meeting of suits who thought this was a good idea.

    #198284 Reply
    Liked by Vagabond MD
    Avatar snowcanyon 
    Participant
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    It comes down to your comfort level with this. NRP is not that hard but it is frightening when you have a bad baby. I never found that adult codes transfer well to newborns but I’m sure I had less experience with it then a seasoned ER doc. Admin will never understand why a doc who had not done something in 10 years since training wouldn’t be able to just jump in.

    I thought you were moving anyways?

    Click to expand…

    Not moving yet, sadly. A year or two, I had hoped.

    It’s not just NRP but arranging transfer (this can take hours in the winter) and taking care of the baby until the chopper or ground arrives. With single coverage.

    #198285 Reply
    Avatar snowcanyon 
    Participant
    Status: Physician
    Posts: 423
    Joined: 10/22/2018

    As noted before, we are employed, unfortunately, so we are under the hospital’s medmal carrier.

    I agree it’s insane. We are “rural” but not that rural in that there is major university hospital and a peds hospital within a thirty minute drive. We have 42 neonatal resuscitations a year, and we are single coverage at night. We do have telenicu, but I’m not really sure what they can do. It sounds like a nightmare.

    Peds is refusing to do it, refusing to come in at all, and they won’t hire NNPs because money.

    The director thinks this is a grand plan to kiss up to admin, so I think this will happen. The other docs are sheeple and will just fall in line. I work in an area where there are docs clawing to work, and not many jobs.

    I think the question is- do I quit over this? Is this the hill to die on?

     

    Click to expand…

    If I recall from previous posts you are looking to pivot to something else anyway, right?  And are in a good position to be able to do so?

    If you loved the rest of your job and everything that came with it, that would be one thing.  But if you are looking for a career shift, I would take this as a sign that it’s time.  It sounds like a bad situation. I can only imagine the meeting of suits who thought this was a good idea.

    Click to expand…

    Anne (and everyone else) thank you for all the ideas, and keep them coming. My job is actually great; it just that EM isn’t for me long term, probably.

    Perhaps this is the reason to speed up leaving and to motivate me. It’s always hard when you feel like you are leaving over a bad policy, I guess.

    #198286 Reply
    Avatar trebizond 
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    Joined: 12/31/2017

    I am trained in IM and peds and there is nothing that scares me more than a crashing neonate, especially one that’s slippery, cold, blue, and apneic right out of the womb. I can recall more than a few cases of babies coming in where someone who was not a neonatologist had attempted intubations and it was….not good. Hypoxic ischemic encephalopathy with seizures and encephalomalacia, intraventricular bleeds with cerebral palsy in the VLBW infants, etc.

    Your adult based instincts which carry over relatively well into PALS will be wrong. It’s not compressions, fluids, epi, and shock. It’s intubate them (meconium everywhere), bag them, warm them, some fluids and pretty quickly pressors.

    I would recommend you say hard no and if they try to push this crap you walk. It’s just not worth the knowledge that with inadequate training you may have played a role in a kid being bedbound and neurologically devastated for life because of prolonged hypoxia and hypotension because there was no 2.5 tube around, no appropriate laryngoscope blades, and you didn’t know how to put in umbilical catheters. Nor the lawsuits that will be sure to follow.

    #198289 Reply
    Liked by Vesalius, jz, Tim

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