At the Children's Hospital of Alabama, we have kids admitted to "wards"
(teaching service); the hospitalist service or to the private community
MD's.  The first two are no problem, as they are all admitted and cared
for by our residents.  Admits to the privates become more problematic.
The privates do not come in to admit their patients and the residents
often have to admit and follow these patients overnight until the
private comes in.  The residents can't stand this policy and it will
likely change soon.

Even more of a problem is at our "After Hours" facility, an outlying (20
minutes from the ED) urgent care facility that is part of our ED
division.  Residents do not work at After Hours, there are a few full
time MD's and several Children's Hospital MD's who moonlight there on
nights and weekends.  These patients have private MD's and when they are
ill enough to be admitted, we have to arrange the admission, ambulance
if needed, orders, etc.  Our division has attempted to limit liability
by contacting the private MD (or on-call MD), discussing the patient
with them and then going over the orders with them.  The child is
admitted to the private MD and we write the orders as verbal orders from
them.  We also clearly state to call the private with all questions
regarding the patient once they arrive at the hospital.

On the other side of the coin, when I was in private practice as a
pediatrician, our ED doctors would write orders and admit any kid for us
that seemed straight-forward and stable (much appreciated by our group).
They admited the kids to us and we assumed care at that point.  They
also knew that we would come in for ANY child that they needed help

I think alot of this question revolves around how comfortable you are
with the MD's you admit for and whether or not they will assume care
(and come in if needed) once the patient is admitted.  I know this was a
long answer, but one that really has been a source of frustration, given
that many of the private MD's don't want to be called by you or the
hospital nurses in the middle of the night.

Aleta Bonner, M.D.
PEM Fellow
The Children's Hospital of Alabama

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