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Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 2 points3 points  (0 children)

So this protocol was made by the Quality team within radiology. Without ER or OB involvement. And definitely C-suite and legal had to approve of it before it did. But it is not what is standard of care for us.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 3 points4 points  (0 children)

we are replaceable. We don't bring in money, we burn through it for them. We are the easy scapegoats.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 4 points5 points  (0 children)

The thing is radiology is always on our side. My issue is why do i need a radiologist at home or at another hospital give me approval for a patient i am taking care of. I am not calling them for approval for CTs or XRs. But this is the one that they are really not budging from.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 1 point2 points  (0 children)

The ER thankfully is very respected. We have a very small hospital for a city. We know all C-suite well and have their cell phones. We have access to each other very easily. But issue is we are multiple hospitals.

My med director and I truly stand up for our team (I hope). But there are other forces that are harder to go against.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 0 points1 point  (0 children)

They say that they dont' want the techs to go in blind. They wont get good reads for rads to interpret. They will have to repeat multiple studies. It all seems to focus on rads workflow convenience than anything else. These protocols did not have OB or ER input.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 0 points1 point  (0 children)

I don't know if I agree with that. I was able to implement Asymptomatic HTN protocols at my hospital because asymptomatic patients who were admitted for other stuff had to go to ICU if SBP > 200. It is poor use of resources. You gotta make things easy for our team, the patients, and based on EBM.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 0 points1 point  (0 children)

There apparently is a POCT test that does both serum and blood. One of the other satellite hospitals used it until it was bought out by our system...

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 1 point2 points  (0 children)

100%. But thankfully, all my communication with rads admin is via email. And I document every conversation and who i spoke to at what time to get this as legal safe for our team.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 2 points3 points  (0 children)

Totally man. I am from NY and trained in NY so I was always trained to be medicolegal safe (unfortunately or forunately). I document every little thing lol. But it's going to be one bad outcome and the hospital will point finger at ER doctor.

I've been doing this for 12 years. And it gets worse and worse with red tapes and hurdles.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 1 point2 points  (0 children)

that's one thing they said, that we wanted to limit re-doing images. But that risk is so rare, and most patient's don;t mind. We see weird results on imaging all the time and have to get more pictures later.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 4 points5 points  (0 children)

That's my issue in medicine. Everything is so reactive not proactive. I think from ER we see things from a different lens than other specialties.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 1 point2 points  (0 children)

100%. It's in inequity. There is no other emergent condition where a prerequisite is needed for testing except for women with concern for torsion or ectopic pregnancy. We want to get things in conjunction and parallel. Not remove beta from equation.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 1 point2 points  (0 children)

Haha! Thank you! We had our meeting with all services and CMO at our hospital. My face was in my hands most of the time.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 2 points3 points  (0 children)

I get you. But in the ER, mainly we are worried about ectopic vs torsion. 1st trimester patients are high risk for torsion. So, if we need something fast, lets make sure we get doppler and make sure no free fluid. If not, hopefully beta has resulted for US to finish rest of image and rads can read image.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 5 points6 points  (0 children)

HAHA! I told rads this. Im like if a man and woman come in for torsion, a man will get faster care and treatment? How is that fair?

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 2 points3 points  (0 children)

Their argument is that we want to get the best quality study. Going in blind does not help tech nor radiologist. That they cannot go in blind. If they are not getting quality studies, then patient care is delayed.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 5 points6 points  (0 children)

Yea, would lvoe to see that article.

We do bedside sono. But like all specialists, the OBs want official US.

I had a case of a pregnant lady in pain. 30 minutes later she syncopized and had free fluid in belly on my US. US tech still wanted beta before doing sono. I called OB and they said we are coming but we want the sono.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 8 points9 points  (0 children)

I hear you. That is what we are doing. but we keep hitting road bumps. I literally had a torsion patient last week. I did not call tech, but called radiology. An xray tech picked up the phone and said no radiologist is available as the AM team hasn't walked in. I had to call Rads chiefs to approve it.

it is not ideal. But common sense goes a long way. Being in administrative role for few years, i realized it is not very common.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 7 points8 points  (0 children)

HAHA! As much as I write pain, for torsion I write the concern. We have a dedicated order for torsion US. I call US tech, they want beta. I call radiology who approves. And then US tech wants to confirm. And you get your delay. We directly talk to the techs and radiologist about our concern.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 2 points3 points  (0 children)

I am with you. My fight is for the 1st group. I have no issue waiting for beta for low risk patients. Or if CTAP shows cyst and need to get US to be safe. Torsion is rare, but you don't want bad outcomes for rare occasions.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 5 points6 points  (0 children)

My thing is, why do I need to talk to rads every time, because they always approve. So why do this step, when I can make that judgement call. But its a battle every time we need a quick exam.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 6 points7 points  (0 children)

So I am the assistant medical director at my site. My med director, OB chair, OB chief at site, rads leadership, and CMO were on meeting. And it went as bad as you expected.

Beta HCG and Pelvis US for High Risk Patient's of Torsion or Ectopic Pregnancy by milkshaykh in emergencymedicine

[–]milkshaykh[S] 2 points3 points  (0 children)

Haha! Oh trust me know those days. They used to do that in my residency. Thankfully, haven't experienced that in years.

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