The Big White Board

When I talk about the white board, I am referring to a large dry erase board where all the patient's information is placed.  Every day at the beginning of the shift we stand in front of the board and talk about each patient listed.  We hear about why they came in, what exams have been done, and what is left to do.  As we "pick up" patients, we place our initials on the line at the end of the patient's information.  That way, everyone knows who is responsible for that patient.  A lot of interesting stories are told at the Big White Board.  Sometimes the attending physicians question us about treatment plans or disease processes, so a lot of learning also happens at the Board.

Understand that this is a very large board.  As I've said before, all 21 rooms are able to be listed on this.  If you look real close, you can see that at 5 a.m. this morning, we had cleared out what had been a full board at 7 p.m. (19:00). 

For privacy reasons you can't see the beginning of the board where names are placed.  Next is the time they need vitals done.  The big space is what's being done/been done, are they being admitted into the hospital or D/C'd (discharged).  The next space is why they came to the ED (btw, SOB stands for Shortness of Breath, it usually is not a comment on someone's demeanor), and the final space is where we place our initials.  You might see the nurses' names along the edge.

Like I said, we had cleared the board by around 5 this morning, so my senior allowed himself to be a guinea pig while I practiced my ultrasound skills.  One of the benefits of this residency program is a strong foundation in ultrasound.  He let me get the goop out and find his liver, heart, kidneys, spleen and bladder.  This is all important when someone comes in that's had trauma. 

A FAST exam (Focused Assessment by Sonography in Trauma) was developed to help determine if someone is bleeding internally.  We can immediately see if someone needs to go straight to surgery or if they have lesser injuries that can be evaluated with some observation and other tests.  We also have the benefit of immediately being able to assess for other diseases without having to wait for an ultrasound tech.  Sometimes having advanced warning about a potentially life-threatening condition is well-warranted.

Officially, I have my ultrasound rotation in November, so I will save the technical aspects until then.  Last night was just a nice introduction with some time, and a lean senior, which made finding the structures easier.

No real thoughts on my patients from last night.  Most of them were pretty sick, and unfortunately, so many people fall through the cracks of the medical system.  Preventative medicine should become a priority in our health care system and people need better access to health care. 

I had a repeat patient who came back with pneumonia.  I'd seen her the week prior and discharged her with a prescription for an antibiotic for her bronchitis.  Her insurance wouldn't cover that antibiotic so she had to wait until morning to call her doctor's office.  They didn't call her back.  Two days later she was still waiting to hear from them, and her pharmacist was nice enough to give her antibiotics in a similar class as the one I had prescribed.  Unfortunately, they did not have the same potency, and she did not get better and came back to the ED now with pneumonia.

Because an insurance company refused a $100 dollar prescription, they will now have to put out about $300 a day for her to be in the hospital, not to mention her labs, chest x-rays, transportation fees, etc.  And, she's one of the luckier ones that actually has some insurance.  Most of our patients don't have any, nor a regular physician.  For all my banter about my patients, I really feel a national health plan for all workers might not be such a bad thing...

ok, no more politicking.  I have the next 3 days off and then I stop being a vampire and return to the real world of working days.  Maybe, I'll finally unpack all the boxes I've been skirting around in my bedroom... :D

Tags: healthcare, insurance, ED, ECMC, ultrasound, FAST exam