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As a fellow who just spent three years escorting PICU patients up to the unit, I can say that for the sickest of the sick, it did seem to have a point although certainly it was a big strain on ED resources. There has got to be a middle ground.

Sick trauma kids,  multisystem NAT kids, intubated head bleeds, Sickle cell ACS kids and brain tumors certainly need an escort of the fellow or attending persuasion.

On the other hand, stable DKAs on drips, stable bronchilitics on VT, ingestions and others who by individual hospital PICU-ED protocol "have" to be there are a bit of a hassle especially during a busy shift. 

Perhaps those are worth discussing as "safe" for nursing/RT only transfer if the PED attending in the department deems it ok after phone handoff with the PICU attending. It can take a fellow/attending or higher functioning resident out of play for up to 20-30 minutes between walking up, waiting for all of the PICU team to be ready to receive report and coming back down after giving a detailed report/answering questions. On a busy night, we all know that 20-30 minutes of lost manpower can result in all kinds of badness/department constipation.

I understand though that we all must figure out what to do so that the patient is best served and safe...not sure what the solution is!!

Good luck to you and your negotiations!!

Evan Allie MD


Sent from my iPhone

> On Aug 10, 2017, at 2:29 PM, Abramo, Thomas <[log in to unmask]> wrote:
> 
> For many with PED & PICU  institution for best practice for patient safety with critical care needs there is a tier level transfer of PED patients to the PICU with no need for resident/fellow ( stable DKA pt, ingestion etc)and requiring a ( intubated, septic)PED Fellow or resident to give a short PED report. Setting the time limit of 10-15 minutes for this hand off resolves a majority of issues and miss perception of the care the PED attendings/fellows have given the patient. With just PED nurse giving patient report this has caused many misconceptions and inappropriate assumptions as to the care given by the PED Attending/fellow. 
> This is nothing new our Pediatric anesthesiology have asked to have a more formalized patient report/hand off to decrease misassumption, critical thinking actions given to the patient etc.
> There was also a CHCA group that developed a formalized process which at Dallas and Vanderbilt we implemented.
> Now I expect my mentor Gene I. To counter my statement.
> Tom Abramo
> 
> Sent from my iPhone
> 
>> On Aug 10, 2017, at 11:50 AM, Todd Zimmerman <[log in to unmask]> wrote:
>> 
>> I would like to formally give you my personal advice on how to best handle this situation...
>> when you speak with the PICU Director, your response should be the following.....
>> "No"
>> 
>> 
>> 
>> 
>> Regards,
>> Todd Z
>> 
>> 
>> Dr. Todd Zimmerman
>> 
>> ** CONFIDENTIALITY NOTICE: This e-mail and its attachments may contain confidential, proprietary, and/or privileged information which is legally protected from disclosure. Any review, retransmission, dissemination, or other use of this information by persons or entities other than the intended recipient is strictly prohibited. If you received this e-mail in error, please notify the sender immediately and appropriately delete the material from your computer. Thank you.
>> 
>> 
>> 
>> -----Original Message-----
>> From: Khan, Naghma <[log in to unmask]>
>> To: PED-EM-L <[log in to unmask]>
>> Sent: Thu, Aug 10, 2017 1:45 pm
>> Subject: Re: Peds ED-PICU Handoff
>> 
>> This is absurd.
>> What makes absolute sense is that they come down to the ED with their multi-disciplinary team to pick up the patient.
>> 
>> 
>> Naghma
>> 
>>> 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
>>> 
>>> 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:
>>>               https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwICaQ&c=27AKQ-AFTMvLXtgZ7shZqsfSXu-Fwzpqk4BoASshREk&r=HEJRpNforjak7UPtlnRrfISdQfYLoHk7Z4NKc39IePk&m=gdAWfsZkJL0LmewPhDsMz-7HDwaHtxgz2IfbJGBlFiM&s=fDdNpoGWdm6V9TekA3NRvXNSn1v1Pw6FBkJDw8Lf6h4&e= 
>> 
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>> 
>> 
>> 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:
>>                https://urldefense.proofpoint.com/v2/url?u=http-3A__listserv.brown.edu_ped-2Dem-2Dl.html&d=DwICaQ&c=27AKQ-AFTMvLXtgZ7shZqsfSXu-Fwzpqk4BoASshREk&r=HEJRpNforjak7UPtlnRrfISdQfYLoHk7Z4NKc39IePk&m=gdAWfsZkJL0LmewPhDsMz-7HDwaHtxgz2IfbJGBlFiM&s=fDdNpoGWdm6V9TekA3NRvXNSn1v1Pw6FBkJDw8Lf6h4&e= 
> 
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