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PED-EM-L  February 2013

PED-EM-L February 2013

Subject:

Re: Ketamine vs. the Anesthesia Dept.

From:

Doc Holiday <[log in to unmask]>

Reply-To:

Doc Holiday <[log in to unmask]>

Date:

Thu, 14 Feb 2013 19:03:52 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (20 lines)

From: [log in to unmask]
> ... I would like to know why Medicaid does not pay for EP provider sedation and looking at the guidance there is no RVU attached....

--> On this hand - I fold. Sorry. The last time I had to understand the value of each item of work was when I was a waiter, back in South Africa, as a medical student. Can't help you there.
But here's my opinion about EP sedation. This is not an opinion of what I think you should do - simply the situation/s I can describe from my own ED.
Some time back, when we had to place some documents in front of some official in some office regarding why we should be allowed to train PEPs in our ED, rather than only EPs, we had to look at paediatric sedation policies in our ED. So we also looked at adult ones. We realised all were too vague, or word-of-mouth only, so someone spent a lot of time working hard and wrote up a good evidence-based sedation policy for children of all ages - right up to 100 years. This then also went through a central guideline archive at our hospital... Just as a matter of routine. It's a mere step on the ladder...
Funny thing was that, within days, we started getting orthopods (even trainee ones of alll stages) coming up to the senior EPs who are in charge at the time and asking us whether we could provide sedation while they pulled in a hip prosthesis or did X, Y or Z for one of their patients. Seems that until we "registered" our policy formally, they had no idea that we could do sedation, even though we have been doing it for years and the guideline did not describe anything other than what we had "always" done. They simply just "discovered" this utility of ours.
Some of the EM trainees got into the habit of saying yes and providing this service for them. Me, being the hard bastard that I am (certified, no less - the wifey being the certifying authority), said "no way". I was not about to become a "service provider" for the orthopods. "This is why the devil made anaesthetists," I told them. They should ask someone from that department to do procedural sedation FOR THEIR PATIENTS, just as they do every day for surgery (I would still be happy to do sedation for my own patients or EM patients, but once we have referred the patient, THEY take over and THEY do what THEY normally do).
"But if we ask an anaesthetist to do sedation, he'll say he wants the patient in the Operating Theatre for it," was the whine I got in reply.
"Then off to the Theatre you go," I'd say. "That's what the Theatre is for. This is an ED and, if we have time to debate this, then you have time to get your paperwork and consent forms and do things the way you always do."
Well-loved by the ED nurses, who'd rather not have to watch these patients - the orthopods will simply do the procedure and wander off...
An added side-effect is that, as they cannot go to the Operating Theatre without a hospital bed booked, these patients get the bed really quickly...
So we sedate for OUR patients, but leave it to anaesthesia to be anaesthesia service providers.
Same funny thing happened when we put through our ultrasound guidelines. For a short while after, as soon as this "new" skill of ours was "discovered", we got a few surgical trainees coming up to us and asking whether we could "do a quick FAST to check if there is a triple-A"... Some of my more polite colleagues (yes, there are a few) would simply explain what FAST was and how it did not make us ultra-sonographers (although some of us are good enough - I know I am not). As for me, being way less polite (see reference to hard bastard above), well, I'd point at the bright lights above, then point at all the large windows in the ED and then say something like "does this look like Radiology to you? Do I look like a radiographer?
We have enough on our plates...
Yup, I tend to write more when it's NOT exactly to the point, but what can you do... 		 	   		  
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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