If the PICU is requesting this to be done, do we think that:

a. the PICU is concerned about the continued teaching of the Peds ER residents/Fellows and wants to demonstrate the fluidity of the continuity of care.
b. the PICU attending wants the resident/fellow to be involved with the initial component of the patients care while the PICU ATTENDING is there teaching away
c. They want another warm body that could be held responsible for the pt?

How about this as a response...
"Sure, that is a great idea...really brings the whole continuity of care thing together...and in the spirit of this great idea, the expectation must be bilateral to even further enhance the experience....Once the resident or fellow believes a pt. needs to be admitted to the PICU, the expectation will be for you, the PICU physician, the RN, and the RT, to come down to the Peds ER, for a multidisciplinary rounding."

Sorry I am being cynical today...

I just had to deal with a community Pediatrician making an accusation that in not so many words that the Peds ER's are not seeing patients that come in, we are diagnosing them with viral syndromes,and sending the patients back to the PMD's because of Obamacare....and making up the medical records on thousands upon thousands of he thinks that we are picking and choosing as some insurances are not paying for non emergencies... do not even get registered with insurance information until AFTER the Medical Screening EXAM is done, and we do not even care or look at insurance EVER....
I mean seriously...

Dr. Todd Zimmerman

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-----Original Message-----
From: Halim Hennes <[log in to unmask]>
To: PED-EM-L <[log in to unmask]>
Sent: Thu, Aug 10, 2017 1:55 pm
Subject: Re: Peds ED-PICU Handoff

We have it in Dallas and have been doing it for years. Works well and good for patient care. Minimal impact on ED workflow

Sent from my iPhone

On Aug 10, 2017, at 2:10 PM, Michael S. Mitchell/Emergency Medicine <[log in to unmask]> wrote:

Good afternoon.

Our PICU physicians are asking that all PICU admissions from the ED have a bedside handoff in the PICU.  Basically, they want a senior resident/PEM fellow to escort the patient to the PICU (about 6-7 min away from the Peds ED) and then give a detailed hand-off (much like rounding) to a multi-disciplinary team in the PICU including RN, MD, and RT.

Their request is incredibly costly for the peds ED as our residents and fellows are usually not expendable.

Have other institutions tried this and found a way that it works?   We certainly see the benefit for that one single patient, but it comes at a cost of caring for the rest of the ED.

Thanks in advance for any advice you can offer.

Michael Mitchell, MD
Medical Director-Pediatric ED

Michael S. Mitchell, MD
Assistant Professor of Emergency Medicine

Section of Pediatric Emergency Medicine

Wake Forest University School of Medicine

Medical Center Boulevard

Winston-Salem, NC 27157

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UT Southwestern

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The future of medicine, today.

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