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:: In 600 minutes November 28, 2007

Posted by Minci 先生 in Medical School.
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10 hours in the admission unit..

There was a lot to do behind the scenes of getting a patient admitted into hospital. Regardless of how ‘little or meaningless’ the presenting complaint seems, it will eventually take one whole day to process the patient. Why?

The admissions unit will get a referral from 2 places : GP or A&E. Then,

  1. Unlike taught in medicine, every patient is subjected to a routine blood test. Eventhough the patient hasn’t been clerked in properly by the doctors. *clerk: taking the history, formulate  a diagnosis and scribe along plans of management*

  2. Initial assessment will include a blood pressure check, breathing, pulse, temperature and oxygen saturations by the nursing staff. In short, getting a baseline reading  of the vital signs. Personal details will be recorded and key points on the ailment will be gathered as well. ECGs are done on most patients. All these basic tasks will be performed by either the nursing staff or medical student.

  3. While the bloods are being sent off to the pathology lab and processed, patients may have to wait around for a doctor or medical student to come and clerk them in.

  4. Having a doctor to clerk in, doesn’t make any patients case go any faster but I do know that if a medical student takes a case, the patient will be given a full ‘MOT’. ;)For patients on many medications, it would be helpful to bring the list. Or remember the dose and time medications are taken.

  5. If an Xray is needed, a card is written up and a phone call is made to the radiographer on call  to tell him/her that we are sending a patient down. Then, it would be their responsibility to contact the porters and get the patient down for Xray.

  6. The wait can be tormenting because a patient who needs an ankle X-Ray for example, would have to give way to more urgent X-rays like the chest.

  7. Once a patients clerked in and examined, they will join the waiting game again whilst the doctor in charge write-up their plan and inform the right people about how to manage the patient. Medical students would do the same thing, only under the supervision of a senior. Usually the registrar.

  8. Write-up includes : Admission  notes, the units admission sheet, ward round sheet, drug charts (if needed), blood results taken earlier.

 

The delay/ long wait is usually caused by:

  1. Not enough staff. One unit can have as many as 10 medical students but if there’s only one senior, that wouldn’t be much of a help either. There’s only so much we could do in the midst of our uncertainties. Then, there’s the wait for porters to take patients for X-rays.

  2. Any results haven’t come back. Eg: blood.

  3. Not enough beds to place patients or room to examine patients.

  4. Communication breakdown. So many phone calls are made and some patients share the same surname. The wrong person might be brought down to X-ray while the correct one go wandering away for fresh air etc. 

 

Within this 10 hours I’ve witnessed about 5 angry patients (dua mmg dasar farked-up : mulut ceghobeh gilak), heard 2 alarms of cardiac arrest (tapi tak dpt pegi sebab dua2 masa tgh ambik darah), bleed lots (take blood), voodoo-ed some (venflon) and managed to help out with a few of the admissions. If there’s anything mundane but important thing I could take away from this experience is that;

  1. If there’s a chance to sit down, then sit.

  2. I must force myself to drink water from time to time.

  3. It’ll be good to sneak in a bit of chocolate or breakfast bars in my bag for quick glucose top-up. A small MP3 player might be useful too to get the beat up since musci is also my form of fuel.

  4. Being nice and knowing your way around keeps you out of trouble. Seek help from the right person gets the job done. Or do them yourselves. 

  5. Time management – still got to have a hang of it.

Comments»

1. cakapaje - November 28, 2007

Salam Minci,

Isk isk isk…teruk gak kat A&E ek. Never thought it was a true scene…baca your story cam tengok ‘ER’ lak. Lagi lak, baca pasal patient no.6 tu, sian dia, kat hospital pun ada orang potong queue.

Delay no.4 tu, kalau buatkan salah orang kena hantar lobotomy, kan naya! Isk isk isk. You take care there.

2. hafiz - November 28, 2007

you must be very busy with admitting patient to the hospital. teruk juga kalau tersilap pesakit. bahaya tu dan boleh kena saman nanti.

3. Minci - November 28, 2007

cakapaje & hafiz,
so far there hasn’t been any serious mistakes sampai tersilap hantar gi lobotomy or anything like that. Selalunya mcm tersalah ambik case notes just because file tuh kat slot patient, looked at a wrong XRay etc.. hence boleh dibetulkan there and then
but yea.. its still a reminder kan.. sebab tuh diajar utk sentiasa check ID of patient.🙂

4. Que - November 28, 2007

for medical students would be best of we can do the clerking and examination and present it to the registrar to get things on track….. and of course present it to the consultant on call during post take ward rounds as that would improve the communication and presentation skills ….. tapi present masa time PTWR adalah sgt mendebarkan sbb time tu lah consultant, registrar, sho, patients and family members mendengar presentasi dgn teliti ….. malu occay + palpitasi mode

5. What is Next | Nautilus IV - November 30, 2007

[…] aje. And at the hospital, hmm… macam biasa.. nak tahu macam biasa tu macam mana so go to 600 minutes . Busy of conducting ISO […]


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