A nurse called me yesterday because a patient was getting worse, fast. So I ordered a STAT CT scan of her head.
So Ms. Nurse asked if I wanted just a head CT, or a if I'd prefer to do a "Stroke Alert!".
This was a new one to me. She explained that a "Stroke Alert!" is a new protocol developed by my hyperactive colleague, Dr. Nerve. When a "Stroke Alert!" is ordered they automatically do a head CT, EKG, a few labs, and call a Nurse Practitioner who's in the hospital to come assess the patient.
So I said what the hell. Let's do a "Stroke Alert!". She said she'd take care of it, and got off the phone.
Roughly 3 minutes later my cell phone rings again. It's the clerk for that floor.
Dr. Grumpy: "This is Dr. Grumpy."
Mr. Clerk: "Yes, I'm calling to tell you that there's a Stroke Alert! in progress in room 52."
Dr. Grumpy: "Um, yes... I ordered it."
Mr. Clerk: "Well, the protocol says we have to immediately notify the neurologist on call for all Stroke Alert! situations."
Dr. Grumpy: "Even if the neurologist is the same person who just ordered it?"
Mr. Clerk: "Look, I'm just following the protocol."
Just another example of a person NOT using their common sense! How frustrating!!
ReplyDeleteNext time order the head CT, EKG, labs, and NP assessment...but as line items rather than a Stroke Alert combo pack. Betcha they do the exact same work w/out the 'protocol' page to the neurologist. ;)
ReplyDeleteOur hospital instituted this stupidity as well. We had a lady 3 days into a small stroke who was complaining of a headache and the neurologist and I, who had just left the room, decided to get another CT. After I place the order, I get a call, "would you like to institute the stroke alert?" The advantage, you see, would be to have an NP examine the patient instead of just 2 board certified physicians. Oh, and we get an EEG, even though we already had a negative one on the chart. And we get to have calls made to the 2 doctors on the case informing us of the stroke alert. Oh, brother.
ReplyDeleteour hospital has a number of automatic page clusters. trauma code, cardiac arrest, regional disaster, stolen baby, bed crunch, etc. i think it is meant to be sure nothing is overlooked in a crisis, and it shows that the hospital has a policy in place. this pleases jhaco. maybe your hospital wants to be a stroke center of excellence. now you know what happens when you push that shiny red button.
ReplyDeleteUmmm, I think you just ordered yourself to come in STAT to evaluate the patient.
ReplyDeleteI LOVE me those protocols !!
ReplyDelete... Another gem from the Department of Redundancy Department
ReplyDeleteWe must not deviate from protocol. lol
ReplyDeleteHaha, ERP's probably right. But seriously, what a mindlessness of this clerk. It reminds me of your entry about the lady who gave you two separate calls because your kids fought in school.
ReplyDeleteThis is not what Atul Gawande had in mind.
ReplyDeleteIt sounds like someone other than the neurologist on call is the one that usually calls for the "stroke alert" if the neuro gets paged when it happens. Maybe someone like intern, hospitalist, resident, etc sets it up.
ReplyDeleteWhile I agree that redundancy is a pain, it can save your hind end in some situations. Better looked at twice than over looked at all.
We have sheets with protocols for common presentations in the veterinary ER: toxicities, GDV, pancreatitis, hit by car/trauma that include several items "marked" or suggested that the Dr on shift just circles which ones apply in that case.
On the one hand, this is a case of someone not using their own judgment and blindly following protocols. On the other hand, do you *really* want this person to use their own judgment??? I'll take blindly following protocols ANY day. . .
ReplyDeleteWe have a stroke alert protocol in our ED but it doesn't include an exclamation point like yours does, and now I feel like ours is lacking. I'm a little jealous, frankly. Ours gets you a CT scan with and without contrast, as well as a bunch of extra paperwork and charting and someone gets the tPA out and sets it on the charge nurse's desk. And everyone feels extra alert. Or, in your case, alert!
ReplyDeleteGotta love it.
ReplyDeletehahahah!!! THAT'S RIGHT UP THERE WITH E-SCRIBING ME THEN CALLING TO MAKE SURE I GOT IT. REPEATEDLY REDUNDANT.
ReplyDeletegood that he followed protocol.
ReplyDeletethe moment he didn't all you smartar$es would be all over him like a rash.
Shortly after flights resumed post 9/11, I was preparing to leave on an early flight out of North Plate, NE. I was the only person on the flight except for the pilot and co-pilot. I checked in at the counter, showed my ID and ticket, and received my boarding pass. Fifteen minutes later they started boarding. The same person that checked me 15 minutes previously now asked to see my ID and boarding pass. Again, I was the only passenger on the plane. Protocol. Aghhh.
ReplyDeleteDid the clerk yell Stroke Alert! at you when he called?
ReplyDeleteI agree with the last anonymous... if he hadn't informed you, he might've gotten in trouble if anything went wrong. Though, he didn't have to play brainless like that; he could have informed you he was documenting that he'd informed the neuro on call of the stroke alert, instead.
ReplyDeleteLook at the bright side.... you won't have to take call ever again this year.
ReplyDelete(The fact that there is only 2 weeks left in this year is irrelevant, I say)
"Look, I'm just following the protocol."
ReplyDeleteAnother perfect example of the mindlessness of bureaucracy..
[head, meet desk]
Oh oh oh... ours is called Stroke CODE and the little pagers vibrate everywhere and half the pharmacy goes sprinting for the TPA. so.much.fun.
ReplyDeleteWe have the stroke alert thingy too although I believe we don't have the NP. In addition to the CT and other tests a stroke alert is an overhead page and generates the arrival of the stroke alert TEAM which includes lab, docs, various other disciplines including the chaplain. The advantage is certainly not the chaplain but the fact that the stroke alert patient gets priority for the CT scanner.
ReplyDeleteThere are (of course) metrics involved.
Your protocol about Stroke Alert is quit interesting that you have to call the neurologist when its start, in any condition.
ReplyDelete@Dr. E: I cannot remember when I have laughed so hard for so long at a comment!! Thank you for your elloquence! You are a gem! :)
ReplyDeleteSo call the hospital back
ReplyDeleteat some annoying period of time (maybe 15-45 minutes, depends on how grumpy you are and how long it takes you to get back to sleep) later and page the doofus who called you about the stroke alert to thank him for letting you know.
Next, get the stupid protocol changed at your earliest convenience to include "Do not call the neurologist who ordered the stroke alert!"
AND ?
ReplyDeleteYou know I like to hear how thinks worked out. Don't leave us hanging like that.
In my hospital I think the stroke alert bumps someone up to the top of the CT list (or at least near the top, say, ahead of the stone study in the VSS twentysomething, but behind the MVC with abdominal tenderness).
ReplyDeleteOtherwise, yeah. Pretty much the same.
well....as some of these "alerts!" are managed by EMR's...garbage in, garbage out.
ReplyDeleteI have be using enough crappy programs that I can imagine that who ordered the stroke alert may not have been easily obtained...
Or using old technology... nurse running (okay...MAYBE calling) the clerk to order transport on a STROKE ALERT!
I can see myself doing this sort of thing. I was the discharge planner...other wise know as the doctors secretaries. (the clerks are the nurses secretaries) lol