Direct Admit/I Did?

Doctor's offices. There are many of them in the town where I work. The normal way I handle them is go in, get the report -- either from the doctor himself or the nurse if the doctor chooses to delegate the task to a nurse. Put the patient on the stretcher (put them on 02 and/or the monitor if they are in distress), take them down to the ambulance, put them in the back, then do what I need to do. I try to avoid working a patient in a doctor's office. I like to be on my own turf.

Lately I have had a couple calls that pose a small dilemna. I get called to a doctor's office for patients who the doctor decides he wants directly admitted to his service in the hospital. Now technically when 911 is activated, you are supposed to transport to the ED, not to a floor. But if you refuse to transport them, it just causes a rash of complications. Mainly you have to sit and wait for a commercial ambulance to come, and they will only do direct admits if the transports are approved by the patient's insurance company, which takes more time. What I have done on some occasions, is just transport the patient to the ED, and when I get to the ED, tell them the patient may be a direct admit to whatever floor. They call the floor, confirm it is a direct admit, then I bring the patient up. To the floor via the ED. Works for me and works for my paperwork.

The dilemna is when you have a cardiac patient, having a cardiac problem, and you go from a cardiologist's office to a cardiology floor. This is what I had today. Patient not feeling well with a pulse of 32, slow afib, dizzy when standing, pressure 88/40, good cap refill, hands and face warm.

What did I do? Put him on 02 in the office, then in the ambulance, put in a line, gave him a little fluid, and did a 12 lead. He probably could have used some atropine. If he was going to the ER from home I would have given it to him, but I felt that I would be going around the cardiologist's back giving it to him on a trip that in reality is a transfer from the doctor to himself.

I feel like I used common sense -- and the floor nurse appreciated the line, but I am a little uneasy on these types of calls. I don't ever want to give a drug because I can, but on the other hand -- here was this guy from all I could see in the notes didn't even get his BP taken, and who could have used some 02. The doctor didn't give me orders for oxygen and I gave that. He probably has no idea that we even carry drugs. I don't know. I get the patient there okay. If he had any change in his condition, I would have done what was neccessary.

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Only other call today was for an abd pain at the Alzhiemer's Home. The patient had no idea why we were there. "You had abdominal pain earlier?" I asked. "I did?" she replied.

This happens all the time at this one nursing home.

Her vitals were all fine. "What have I done to deserve this treatment?" she protested as we put her on the stretcher. "Unhand me. Unhand me right now!"