I was just sitting here when I was called STAT to ER to do a holter Monitor. Normally I wouldn't gripe about ER calling me no matter what the reason when I'm just sitting here, but it was a STAT holter Monitor, so it warranted a groan and a gripe.
I don't know if all RT departments do holter monitors, but I know that most of the ones in this area do. However, we have other staff do them during the day shift, and RT just has to do them at night.
Which, one would think, would cover all holter orders, considering holter monitors are an outpatient procedure. But, lo and behold I get called to do at least one STAT holter monitor a week.
And, usually, it's during a time when I'm really busy.
When you are the only RT working, you learn to prioritize your therapies, and I can find very few things, aside from a STAT IS, that a holter set-up should be ahead of. Occasionally, I've been known to take over an hour just getting to the holter.
"This is the ER," one doctor told me once, "nothing in ER deserves to be put off for over an hour."
My short-of-breath patients on the floor are more important than this holter, that I shouldn't have to be doing in the ER in the first place, I thought. Yet I smiled and said, "Sorry."
If there are any readers of this blog out there who can think of one reason why a holter needs to be ordered in ER, please let this RT know. I can think of none.
Because the patient has chest pain?
Hardly. If he has that symptom he should be admitted.
What about if the patient had a fast heartbeat, but when she got here we didn't pick up anything on the rhythm strip or EKG?
If that patient is symptomatic, admit them. Otherwise, schedule them for an outpatient holter.
Another goofy thing we do after giving a patient a holter is give them this little log book for the patient to record any symptoms they might have such as chest pain, palpitations, etc.
If the patient is having these symptoms, they shouldn't be recording it in a log book, they should get themselves back to the ER.
Does a holter need to be ordered stat? Absolutely not in my humble opinion.
On the other hand, if the ER doctor called me and said, "Hey, if you guys have the time, and a holter monitor available, we would love it for you to put one on a patient so she doesn't have to come back in two days to get one."
If that happened I'd be ecstatic about doing the holter. In fact, it might cause me to have chest pain, and then I'd need a holter set up on me.