So a patient is having a severe allergic reaction and is hypotensive. She became lightheaded and almost passed out when assuming the upright position. She has something we call orthostatic hypotension. Her blood vessels are all dilated out and can't constrict due to the severe allergic reaction. She was placed on IV steroids, IV benadryl, IV pepcid, and Zyrtec. Not bad right?
I was covering this patient on the weekend. It turns out the other internist who has this patient ordered a neurology consult. The nuerologist in turn ordered an MRI and MRA of the head and neck.
Why?
I have no idea why the neurologist needs an MRI and MRA of the head and neck to figure out why this lady nearly passed out. You'd think it's pretty obvious. But apparently, it's not obvious to the neurologist.
They called the neurologist overnight with the consult, and he does what any good neurologist does and orders a MRI/MRA.
Why?
There is so much pressure to shorten length of stay. That doctors don't think any more. They just react. Hospitals hire staff called "case managers" to help get patients out. Their job is to push physicians into discharging patients, to shorten "length of stay". The shorter the LOS, the more money a hospital makes.
Nothing wrong with that, but it pushes physicians into "hurry up and order everything so we can get them out by the end of the day" type of mentality which is wrong.
When you consult cardiology for a simple consult, they page the cardiologist and the patient has a panel of tests ordered (stress test, echo, carotid, ekg) without the cardiologist even talking to the patient and seeing what they really need.
Is this push to shorten length of stay a good push?
Unfortunately, while you may be shortening length of stay, the number of tests and orders that are done has quadrupled. That costs more in the end. Costs are going up, not done.
Hospitals need to fire the case managers and let doctors get back to being doctors and let us manage our cases.
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