LISTSERV mailing list manager LISTSERV 16.5

Help for PED-EM-L Archives


PED-EM-L Archives

PED-EM-L Archives


PED-EM-L@LISTSERV.BROWN.EDU


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

PED-EM-L Home

PED-EM-L Home

PED-EM-L  January 2018

PED-EM-L January 2018

Subject:

Re: PED-EM-L Digest - 5 Jan 2018 to 6 Jan 2018 (#2018-5)

From:

Mick Work <[log in to unmask]>

Reply-To:

Mick Work <[log in to unmask]>

Date:

Sun, 7 Jan 2018 06:47:19 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (226 lines)

My .02 in the PIcu.   Do what’s best for the patient and what’s within your training, comfort level and available resources.   My threshold would be mighty low for transfer if no picu RN or picu md availability.  

On urgent care etc., is anyone fostering discussion on the big picture of pediatric emergency medicine?  25 years in, seems pem needs a broader discussion of where this field is and where it should be going.    Training, research, volume demand, longevity, distribution of resources, psych shortage, the list goes on. 
Just curious. 


Mick Connors



> On Jan 7, 2018, at 12:00 AM, PED-EM-L automatic digest system <[log in to unmask]> wrote:
> 
> There are 4 messages totaling 291 lines in this issue.
> 
> Topics of the day:
> 
>  1. PED as PICU overflow unit (2)
>  2. George Koburov: PED as PICU overflow unit
>  3. Pediatric Urgent Care Fellowship
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ----------------------------------------------------------------------
> 
> Date:    Sat, 6 Jan 2018 05:06:05 +0000
> From:    Camel chav <[log in to unmask]>
> Subject: Re: PED as PICU overflow unit
> 
> This is wrong on multiple levels
> Even if ED MD providing care
> 1. Floor patient coming to ED  - Billing as an ED physician - wrong
> 2. Liability issues: ED insurance will not cover you as it will likely be proved that it was not covered under your insurance
> 3. ED busy place and inability to basically to do intensivist/hospitalist work-increase risk
> 4. Would say a categorical no to this!!!!
> 5. Surprised your legal department is letting this happen ( Tney might be like Trump administration- Mad house)
> 
> Kamal
> ________________________________
> From: Pediatric Emergency Medicine Discussion List <[log in to unmask]> on behalf of Melissa M Tavarez <[log in to unmask]>
> Sent: Friday, January 5, 2018 4:33 PM
> To: [log in to unmask]
> Subject: Re: PED as PICU overflow unit
> 
> At our institution, For times when the PICU full, overflow patients are
> usually placed in PACU beds with, I believe, PICU nurses and they are
> covered by the ICU physicians.  We may occasionally board an ED patient for
> a few hours if beds are not available, even if they are intubated, but I
> have never seen a deteriorating inpatient transferred to the ED as a step
> up in care.
> I echo that particularly from a nursing perspective, it is not appropriate
> to have the ED be the pop off valve for this situation.  It is too much to
> ask them to care for a patient who requires ICU level care and also have
> 2-3 other patients, overall it is just a set up for errors when folks are
> that taxed.
> I don't think it's unreasonable to board and manage primary ED patients,
> but getting kids from the inpatient unit seems like a very poor solution.
> I commend your group for being such great colleagues, but it's less about
> physician expertise and more about all the resources that are needed to
> provide high quality care, and abusy ED is just not the ideal place for
> these inpatients, because if you think about it, if they had presented that
> way to the ED, they would go straight to the PICU!
> 
> just my thoughts
> 
> Mel
> 
> 
> On Jan 5, 2018 9:30 AM, "McDonnell, William" <[log in to unmask]>
> wrote:
> 
> Because our PICU is increasingly at capacity and "closed" to additional
> patients, our hospital has begun designating the ED as "PICU overflow."
> Hospital inpatients who deteriorate on the floor are taken to the ED, and
> handed off to the ED physician for management. Our ED physicians are
> comfortable with immediate resuscitation, but are unhappy with managing
> ventilators and ventilator sedation for extended periods, as well as trying
> to manage these often-complex patients with multi-system issues, all the
> while running a busy ED. Are other hospitals using the PED as a PICU
> overflow for deteriorating in-patients? If so, do you place any limits on
> who manages these patients, for how long, and with what assistance (e.g.,
> co-management with hospitalist or critical care doc)?
> 
> Thanks for sharing your thoughts and/or experiences.
> 
> Bill McDonnell
> 
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ------------------------------
> 
> Date:    Sat, 6 Jan 2018 11:28:04 +0000
> From:    Gill Winnik <[log in to unmask]>
> Subject: Re: PED as PICU overflow unit
> 
> Not done here
> I would be concerned also with the legal risks where you are managing ( and billing) as an Intensivist while it may be out of your qualifications.
> 
> Giora Winnik/ Maimonides Brooklyn
> 
> Sent from my iPhone
> 
> On Jan 5, 2018, at 10:26 AM, McDonnell, William <[log in to unmask]<mailto:[log in to unmask]>> wrote:
> 
> Thanks Mathew.
> In our experience, there has NOT been any PICU fellow, PICU resident, or PICU attending involved.
> 
> From: Mathew George [mailto:[log in to unmask]]
> Sent: Friday, January 05, 2018 8:39 AM
> To: McDonnell, William
> Cc: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: PED as PICU overflow unit
> 
> Will there be a PICU fellow or resident staying with the patient in the ED with PICU attending backing or are you completely responsible for thr care. If its former , it is not too bad
> 
> On Jan 5, 2018 9:30 AM, "McDonnell, William" <[log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]>> wrote:
> Because our PICU is increasingly at capacity and "closed" to additional patients, our hospital has begun designating the ED as "PICU overflow." Hospital inpatients who deteriorate on the floor are taken to the ED, and handed off to the ED physician for management. Our ED physicians are comfortable with immediate resuscitation, but are unhappy with managing ventilators and ventilator sedation for extended periods, as well as trying to manage these often-complex patients with multi-system issues, all the while running a busy ED. Are other hospitals using the PED as a PICU overflow for deteriorating in-patients? If so, do you place any limits on who manages these patients, for how long, and with what assistance (e.g., co-management with hospitalist or critical care doc)?
> 
> Thanks for sharing your thoughts and/or experiences.
> 
> Bill McDonnell
> 
> For more information, send mail to [log in to unmask]<mailto:[log in to unmask]><mailto:[log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=djx4x_Lu5jS1_mKMB7WBGhXdIwpne1KOnJAaisGB74Q&r=exvi3q-J52PR7GzZVteuwfhRX2j70zxRa9Sp7tvqwdc&m=8r8GI5p0TG-_zgdOk6wQreB6Dt8iwpwFf6hlVWC9LfM&s=HB_hPersMyufKMpKLcCYMGjtgIIGBUJ9u0stey26BFU&e=<https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwMFaQ&c=DnANjVtvz6soFAeufrdBN-5Q9R87-pGPRepzsRZj-u0&r=uMFTROa4WbfUruhtR8jBvf4B8k9IKsoCbHPYwu4nuoA&m=cHOOcUSEUdsDJvlC6kOY6gNJoOSmGj6vQklgj5VI2Hk&s=bYe5McQic9Ks5mzVoBHcCNLYy2DxWCoAUJSDBfVSfCQ&e=>
> 
> For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwIGaQ&c=djx4x_Lu5jS1_mKMB7WBGhXdIwpne1KOnJAaisGB74Q&r=exvi3q-J52PR7GzZVteuwfhRX2j70zxRa9Sp7tvqwdc&m=8r8GI5p0TG-_zgdOk6wQreB6Dt8iwpwFf6hlVWC9LfM&s=HB_hPersMyufKMpKLcCYMGjtgIIGBUJ9u0stey26BFU&e=
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ------------------------------
> 
> Date:    Sat, 6 Jan 2018 23:26:01 +0000
> From:    DocMatter <[log in to unmask]>
> Subject: George Koburov: PED as PICU overflow unit
> 
>    
> Our hospital suggested this and we flatly said NO.  It is not in the interest of anyone patient included.  IF a new patient shows up to the ED who needs PICU and they are full we may hold them if we think we will get a bed in reasonable amount of time (4-6 hours).  If not, we transfer them out to another institution.        
>        
>        
> George Koburov MD            
> Direct Reply: https://www.docmatter.com/georgekoburov           
> Chief, Pediatric Emergency Medicine            
> University of Missouri        
> Columbia, MO  USA        
> 
>       
> 
> This is a reply to the discussion started by William M. McDonnell MD, JD:         
> 
> Because our PICU is increasingly at capacity and "closed" to additional patients, our hospital has begun...        
> Full discussion:           
> https://www.docmatter.com/dm/svc/links?link=8D742C2C304C4342F7C014C50ECBC8FF&tk=eo_60f1e285-d8c3-4abf-af0c-0fc3e19138f9_yOckJzh1SAqgmkFgfn3ON4s2WmDPnVbiW5P9         
> 
>         
> ===============================================================                    
> George Koburov uses DocMatter to manage, filter, and archive ListServ emails.            
> To request your free access to DocMatter please email [log in to unmask]        
>    
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ------------------------------
> 
> Date:    Sat, 6 Jan 2018 17:46:35 -0500
> From:    Chris Ramsook <[log in to unmask]>
> Subject: Pediatric Urgent Care Fellowship
> 
> Phoenix Children’s Hospital is proud to offer a new Pediatric Urgent Care Fellowship for the academic year 2018-2019 in Phoenix, Arizona. Given the increasing number of pediatric urgent care centers nationally, most pediatric residents graduate without adequate exposure to the urgent care experience and the career opportunities that it offers. This is the perfect opportunity for someone interested in acute care pediatrics including procedures but not the high acuity and complicated 
> patients of a pediatric emergency room. We are offering a 1 year program designed to train graduating residents and general pediatricians to practice in this high acuity, fast-paced environment. Our goal is to create experts in the emerging field of pediatric urgent care medicine who will become leaders in the field. Phoenix Children’s has four urgent care centers at 4 corners of the city that sees over 50,000 patients per year combined at all sites. The urgent care centers function with the backup of an emergency department that is readily accessible and has over 85000 annual visits as well as a tertiary main campus for inpatient and subspecialty care. The fellows will receive their training/ supervision by general pediatricians and pediatric emergency medicine faculty/ fellows who all cover the urgent care sites. The entire spectrum of subspecialists are on call for both urgent care as well as the emergency department. 
> 
> Summary of the Program Structure and Overview
> 
> Rotations               Duration in Weeks                  Clinical UC hours per week
> Core UC rotations     28                                                   32
> PTO/CME                      4                                                    -
> ED                            4 (2 main, 1 ext, 1 RMA)                 -
> General Surgery    2                                                   20
> Plastic Surgery            2                                                   20
> Orthopedics            2                                                   20
> Sports Medicine      2                                                   20
> Radiology                    2                                                   20
> ENT                            2                                                   20
> Ophthalmology        2                                                   20
> Dermatology            2                                                   20
> Total                          52                                               1216
> 
> This fellowship is anticipated to produce well trained and motivated urgent care physicians for whom the demand is expected to increase both internally and externally. We hope to hire as many as possible with a competitive compensation package that recognizes the formal urgent care training and experience upon completion of fellowship. Interested candidates can email the program director, Chris Ramsook MD at [log in to unmask] or call 6029331910 for additional information.
> 
> Chris Ramsook MD
> Attending Physician, Emergency Department
> Phoenix Children's Hospital
> Director, Urgent Care Services
> Phoenix Children's Hospital 
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
> 
> ------------------------------
> 
> End of PED-EM-L Digest - 5 Jan 2018 to 6 Jan 2018 (#2018-5)
> ***********************************************************

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

Top of Message | Previous Page | Permalink

Advanced Options


Options

Log In

Log In

Get Password

Get Password


Search Archives

Search Archives


Subscribe or Unsubscribe

Subscribe or Unsubscribe


Archives

September 2019
August 2019
July 2019
June 2019
May 2019
April 2019
March 2019
February 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004
September 2004
August 2004
July 2004
June 2004
May 2004
April 2004
March 2004
February 2004
January 2004
December 2003
November 2003
October 2003
September 2003
August 2003
July 2003
June 2003
May 2003
April 2003
March 2003
February 2003
January 2003
December 2002
November 2002
October 2002
September 2002
August 2002
July 2002
June 2002
May 2002
April 2002
March 2002
February 2002
January 2002
December 2001
November 2001
October 2001
September 2001
August 2001
July 2001
June 2001
May 2001
April 2001
March 2001
February 2001
January 2001
December 2000
November 2000
October 2000
September 2000
August 2000
July 2000
June 2000
May 2000
April 2000
March 2000
February 2000
January 2000
December 1999
November 1999
October 1999
September 1999
August 1999
July 1999
June 1999
May 1999
April 1999
March 1999
February 1999
January 1999
December 1998
November 1998
October 1998
September 1998
August 1998
July 1998
June 1998
May 1998
April 1998
March 1998
February 1998
January 1998
December 1997
November 1997
October 1997
September 1997
August 1997
July 1997
June 1997
May 1997
April 1997
March 1997
February 1997
January 1997
December 1996
November 1996
October 1996
September 1996
August 1996
July 1996
June 1996
May 1996
April 1996
March 1996
February 1996
January 1996
December 1995
November 1995
October 1995
September 1995
August 1995
July 1995
June 1995
May 1995
April 1995
March 1995
February 1995
January 1995
December 1994
November 1994
October 1994
September 1994

ATOM RSS1 RSS2



LISTSERV.BROWN.EDU

CataList Email List Search Powered by the LISTSERV Email List Manager