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Friday, August 28, 2009


I have to give kudos where kudos are due. I have to give kudos to the ER boss and the nurses of the ER for listening to and incorporating the advice of this and other RTs.

As I have written on this blog before, it was getting to the point that EKGs were ordered for such frivolous orders, or the patient wasn't available when the RT dropped what he was doing and rushed to ER, that many of us RTs stopped rushing to do EKGs in the ER.

It got to the point our EKG response time was really bad, like 20 minutes. That's not good, especially when you have a patient who is having life threatening chest pain -- or an MI (a heart attack). In these situations, an EKG should be done within 10 minutes from the time the patient entered the door.

ACLS also recommends such EKGs be done within 10 minutes. Yet, still, there were so many stupid EKG orders that we RTs stopped rushing down. I suppose they desensitized us to the word STAT.

Now, I recommended to my RT Boss that ER should call us stat for ACLS EKGs, and ASAP for all others. That way we can prioritize, and if we can't get down right away we can call and the ER staff can do the EKG. My boss said, "There is no reason you should ever not get down to ER right away to do an EKG."

That ended the discussion. A while later I talked to the ER Boss, and she liked my idea. But, five years later, nothing ever changed.

Now, however, my idea is implemented and going well. The door to EKG time has improved from 20 minutes three months ago to 8 minutes. That's great.

In fact, yesterday one of the nurses pointed me to a sign on the window that notified us of this great improvement, and the nurse said, "Kudos to you."

I said, "No! Kudos to you and your boss."

I meant that. Now that the ER staf page us RTs STAT for procedures that should be done STAT, we know that when we get paged STAT it means STAT.

Of course it took money for the change to finally be implemented. Six months ago the head RN boss noticed that insurance companies will pay for any EKG on patients over 29 complaining of atraumatic chest pain. She also noticed that they weren't paying for most of our EKGs because the door to EKG times were way too often greater than 10 minutes.

So, she got one member from each department together at a meeting to determine what could be done to speed up the time from door to EKGs.

I was picked by the RT boss to represent the RT Cave. My suggestion was simple: "Call us STAT only for ACLC EKGs. In other words, call us STAT for Atraumatic Chest Pains."

The idea was implemented. And, no surprise, it works. We RTs are happy because we know exactly when we need to rush, the nurses are happy because they no longer have to complain we took too long, and the RT Bosses are happy because they get paid."

So, kudo's to the bosses at Shoreline Medical Center. You've earned it.

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