Saturday, November 22, 2008

Going, Going, Gone

In my last post, I talked about a transfer I had yesterday.  Interestingly, this was the third patient in a row for me that needed to be transferred, making for quite a busy afternoon.  I guess there is no better way to see the limitations of our smallish community hospital than to get a retinal detachment that can't be seen there (no opthamologist on call) followed by an SI* that wanted to go to inpatient psych (no mental health at this hospital) followed by the mandibular fracture (no maxillofacial surgeons).

Other cases that we have to transfer out: any seemingly imminent pregnancy (no L&D), bladders that can't be cathed (no Urologist), STEMIs (no cath lab), Renal Failures (no dialysis), high-level traumas (We are level 4), head bleeds (no neurosurgeon).  Probably others.

We certainly aren't huge (I recently toured an 80 bed ER that just kept going and going and going), but at the same time, it isn't that we are some podunk ER.  In fact, our department is fairly moderately sized (25 beds) and stays pretty busy with a good inflow of patients.  I think it is more that fact that the hospital that we are attached to has less than 100 beds (one ortho unit, one med/surg unit, one PCU/stepdown unit, and a 12 bed CCU).  This kind of hospital, with no surgical specialty unit, no pediatric unit, no renal unit, no oncology unit, no neuro unit, no mother-baby, and a cafeteria that only serves hot food for a couple hours at a time three times a day is not likely to attract the best and brightest specialists around.

The upshoot, I suppose is that I get really good at this end of the ambulance transfer system, and the EMTs get really good at standing around watching me frantically finish up last minute details so that I can get the patient out the door.

* by SI I mean suicidal ideation, and not, as you may assume, Sports Illustrated. I think our hospital would do just fine in taking care of Sports Illustrated, thank you very much.

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