Saturday, October 31, 2009

Ineptitude? No Way…

Got sent earlier today to one of the area nursing homes to transport a patient to one of the ED’s for a “cardiac problem.” I’ll note that this was not my “Favorite Nursing Home”, which was a good thing. But to say I was somewhat mortified at the issues I encountered would be a bit of an understatement.

Dispatched for a 90 year-old female with the question of arrhythmia. Arrived at the facility and went to the floor where the patient was located. I took report from one of the nurses, and it consisted of information relayed to me that sounded something like this:

The patient was discharged from the Crummy Hospital yesterday to here after being seen and evaluated for a syncopal episode. She has a Holter Monitor on, and we were supposed to get a report for the cardiologist at 7:00AM. We actually didn’t get it until about 11:00, and when we sent it to the cardiologist he thought she needed to be seen and evaluated. Does this look like it’s serious? I’m not sure.

Now I don’t remember the exact words she used, but they were pretty close to what I wrote. And when she showed me the report, I immediately understood why the cardiologist wanted her to be seen.

She was having a run of what looked to me like Ventricular Tachycardia. And, to say that it got my attention was a serious understatement.

I went to the room where our patient was located. My partner was already there talking with her and her son, who was also there. I was quite surprised at what I found: patient was sitting upright in a straight backed chair. She was fully dressed, alert and oriented to person, place, time, and situation, and she was completely engaged. Very intelligent, definitely with the program, and she was understandably frustrated. She’d had a total of four syncopal episodes, approximately one a week over the past month. Other than the run I mentioned, there were problems with the Holter Monitor not working properly when it was needed most. And she – and her son – wanted some answers.

Initial assessment was unremarkable; as I said, she was alert and oriented times four with warm and dry (buy slightly pale; apparently her baseline) skin. A quick set of vital signs showed a blood pressure of 126/74 with a heart rate in the high 80’s. Our cardiac monitor showed a sinus rhythm with an occasional PVC. Other than a first-degree AV block, the 12-lead ECG was non-diagnostic. Blood glucose was at 129. Temperature was almost spot-on normal. Patient denied chest pain or shortness of breath, and lung sounds were clear in all fields.

So we transported her to the Brigham and Women’s at both her and her son’s request. When we arrived at triage, the nurse was confused about why we were there instead of the other hospital. And the patient got confused. And I got confused.

It was awful.

Once we got her into a treatment room and a doc (one of the cardiology residents, thank goodness) we were able to get it straightened out. All of that said, I wasn’t really impressed with the way everybody involved handled it. It certainly could have been dealt with better.

And I hope they can get to the bottom of what’s happening with her.


TOTWTYTR said...

Not to be harsh or anything, but my experience with nursing home and clinics has been that they don't tend to attract the top grads from medical or nursing schools.

Just saying.

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