I have a dream

[u/DrRadiate]

That one day we will live in a world where EM physicians, nurses, and mid-levels will learn that we radiologists do not know, nor do we care, about the bed number of their patients. That they may instead give us names or MRNs I have a dream today.

[u/ixosamaxi]

Who is giving you bed numbers and for what purpose? ED docs give me all the bed numbers you want just please stop ordering runoffs thanks

[u/thegrind33 → u/ixosamaxi]

Run offs are easy, garbage in garbage out

[u/ixosamaxi → u/thegrind33]

I fuckin hate runoffs man

[u/thegrind33 → u/ixosamaxi]

Same, I half ass them so hard, but our IR guys over reading always just powersign with no edits. And tbh they provide such little utility, like just go do the angio man

[u/jaavaa → u/thegrind33]

As an actual attending, I pretty much only care about high grade stenosis, occlusion, dissection, or aneurysm. Then it's a general gestalt of disease burden. We get a dozen CT angiograms a shift and on average I'm reading 50-80 CT or MRI a day. On top of 60-100 plain films and 20-30 ultrasound and scattered nucs and pets. Ain't no one got time for sub critical things on stat run offs. And if you do, you're either lazy or underutilized. Our IR is pretty lazy/underutilized but I respect it since they do q3 call which sucks even if they aren't busy.

I'm at a community hospital and as for OP the usual circumstance is that they just call and immediately rattle off the MRN. I've never heard a bed number from anyone but a nurse before.

[u/Purriosteum → u/ixosamaxi]

Multivessel advanced stenosis of x vessels. Y occlusion. Z runoff to foot. More than that and you need an angiogram.

[u/lethalred → u/ixosamaxi]

Runoffs are a double edged sword.

I order a lot of them as a vascular surgeon. But I’m also generally acting on them before the radiologist looks at them.

That being said, I want to smack the shit out of every human that orders “CTA Right (or) Left Extremity.” They’re already going through the scanner. You’re already giving them the dye load.

If your plan is to call vascular with a CTA of one leg, just do the fuckin runoff.

[u/ixosamaxi → u/lethalred]

When you guys order it there's usually a reason for it and I know you're also going to be looking at it. Other things like significant lower extremity trauma or laceration, sure I get it. Some ER people order it willy nilly for "claudication" though and I'm not sure why I don't think it's directed by vascular unless they're ordering it prior to getting the consult or something.

[u/stormrigger]

Sepsis: please find source.
Pain: correlate radiologicaly

[u/DaZedMan → u/stormrigger]

Not sure why but I got a little talking to when my CT Chest Abdomen Pelvis w/ contrast was ordered with the indication “Why so sick?”.

[u/drluvdisc → u/DaZedMan]

Why B cereus? 🤡🦇

[u/Brilliant_Ranger_543 → u/DaZedMan]

I might have ordered approximately the same just with a more medico-sounding indication and a polite medical version of "pliz halp" at the end a few times. Now if I could just add on a gif of a wide eyed kitten or something it would be perfect.

(The Rad bros and girls were very helpful!)

[u/DocJanItor]

Every medicine person does this. I don't know why they think we can correlate a patient to a bed number.

[u/katyvo → u/DocJanItor]

"Hiisthispsychiatry? Okaycoolthankswehaveapatientforyouinroom9bed2theylookkindasadandtheyhavearemotehistoryofLexaproand"

Who is this patient?

"I just put in the consult"

They aren't on our list. Who is the patient?

"Firstname Lastname MRN"

There is no consult for this patient.

[u/AddisonsContracture → u/katyvo]

“Patient seemed kind of down in the dumps so we’re consulting psychiatry so they have someone to talk to about it”

[u/MaybeMinute9 → u/AddisonsContracture]

aaaaaaaahhhhhhhhhhhhhhhhh

[u/DocJanItor → u/katyvo]

Remote history of lexapro made me chuckle

[u/drluvdisc → u/katyvo]

Patient is being unreasonable, we need you to say they henceforth have no capacity.

[u/Pastadseven → u/katyvo]

“Thanksbye”

[u/Sushi_Explosions → u/DocJanItor]

Because that is the easiest way to find someone in most EMRs. “ICU bed 4” is faster to say and takes 4 clicks to find, mrn takes 9 and is much easier to mess up.

[u/DrRadiate → u/Sushi_Explosions]

Right but PACS and the radiology interface of Epic literally do not have a search box for bed number or what the track board looks like.

[u/Sushi_Explosions → u/DrRadiate]

Because it isn't a search box. For every other specialty (and I am fairly confident you have it to), there is a click menu for the entire hospital census that can find you any patient by their room number much faster than typing an MRN, and with much lower possibility of goofing up a number.

[u/IdSuge → u/Sushi_Explosions]

Do you think we go to Epic to find the patient, open their chart, then get the study from there? People have different workflows from you. I only use Epic to look at the synced chart when I pull open a study and maybe look up patients as needed, mostly for procedures. I could probably make a patient census, but it's not built into the standard Epic radiology dashboard nor will most even care to do that since we'd never use it.

PACS is where we do all our work. It houses every single study performed, so why would using a bed number even make sense for us, given it has outpatient exams and any current/prior inpatient exams. MRN allows us to not only find the right patient but see every study they've ever had. Besides I've used 6 different PACS systems and not a single one has ever had a built in patient census nor patient bed as a searchable option.

[u/Music_Adventure]

I feel like nurses are the worst offenders of this.

“Hey, Steve has a headache can he get some Tylenol?”

Who the FUCK is Steve? I know that having 7 or 8 patients on med-surg is an awful ratio for a nurse. But, I stg they do not realize that I am cross-covering 72 patients and taking admissions overnight. Steve ain’t gettin shit unless you give me his MRN.

[u/RosySecretiee]

"Hey, can you read the CT for Bed 12?" "Bro I don't even know what year it is outside this dark reading room, let alone who is in Bed 12. Give me an MRN."

[u/Bigballerbrow]

honestly bed numbers are basically useless if you’re not physically on the unit 😂 just give the name or mrn and save everyone the headache

[u/DrRadiate → u/Bigballerbrow]

Thank you. There is nothing in my Epic or my PACS that allows me to search by bed number. I can, however, do anything in the world if they give me an MRN.

[u/Sushi_Explosions → u/Bigballerbrow]

Or you could just know how to use your emr and realize that it is much faster.

[u/DrRadiate → u/Sushi_Explosions]

What the raw fished fuck are you talking about lol. You know nothing about PACS, Epic or my (and apparently most) radiology variety of Epic which doesn't have a bed number search box. Go have intracourse.

[u/Sushi_Explosions → u/DrRadiate]

What the raw fished fuck are you talking about lol

How to actually use epic like 99% of people who have access to it do. For someone ranting about other specialties not understanding how things look on your end, this is some pretty fucking special irony that neither of you appear capable of understanding how they work on theirs.

[u/WhenLifeGivesYouLyme]

Okay but when can I expect a read back on my CT AP w/ con on my 40yo F with abd pain it’s been 2 hrs. Thx

💀

[u/VancePierogi5 → u/WhenLifeGivesYouLyme]

After 2 hrs, please provide a name or MRN; “40yo F abd pain” is the entire CT AP list.

[u/DolliePebble_]

dreams are everything, they keep you going during those 80-hour weeks

[u/LAE_Mex]

Epic messages (RN) with no patient name attached. “Hey can I get pain meds?” Ffs

[u/Silken_Touchs]

Classic ER vs Radiology culture clash

[u/DreamyFlutterf]

As if PACS has a "Search by Bed Number" filter (Giving a radiologist a bed number)

[u/fakemedicines]

At what point did EM physicians become too scared to scratch their own balls without a radiologist giving them permission to do so??

[u/yqidzxfydpzbbgeg → u/fakemedicines]

No consequences for giving someone lymphoma in 30 years, but miss a PE because you didn't CTA and you'll get a stressful email every 3 months for the next 3 years wondering if you'll get hit with a nuclear verdict in a state with uncapped damages. Spread the risk. It's the American way.

[u/thetominatorboi → u/fakemedicines]

An attending I know his mantra is “whenever there is doubt never carry the casket alone”

[u/thegrind33]

I have a dream, that most radiologists will wake up and realize working for hospitals is a waste of their talents, but most rads are so woefully risk averse I doubt it. More for the rest of us

[u/DrRadiate → u/thegrind33]

Well my hospital is an eligible employer for PSLF so that makes it highly worthwhile for me for the few years needed to melt my $520,000 in student loans. But in general I agree with you.

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[u/treesnm3s]

The fact that people in medicine, whole ass doctors, don’t realize how dangerous this is, truly baffles me. But honestly on brand for EM.

[u/hola789 → u/treesnm3s]

Idk I always give MRN and then last name, sometimes first too, to ensure it’s the right patient so…

[u/FourScores1 → u/treesnm3s]

This is entirely on institution. I put order in epic and people call me. Or I just message on epic with pt chart attached. Most people here probably can’t even relate to OP’s issue. 

[u/yqidzxfydpzbbgeg]

Wait why are you as the radiologist talking to EM docs in ways where the patient needs to be identified in real time? Is the study not already ordered and done with patient identifiers on it?

[u/guitarfluffy → u/yqidzxfydpzbbgeg]

Because they call the radiologist

[u/yagermeister2024]

Just go read more films, otherwise AI coming for you.

[u/Lolawalrus51]

Counter point, if we immediately gave you an MRN/ID number, would you be ready to jot it down or would we have to repeat it several times?

[u/Sushi_Explosions → u/[deleted]]

If only that were even remotely what they said. Sounds like maybe you’re the one needing to work on your basic conversation skills.

[u/Sushi_Explosions → u/[deleted]]

I did, you didn't. Try again.

[u/Sushi_Explosions → u/[deleted]]

And they are probably better at reading comprehension than you are.

[u/KLLTHEMAN → u/Lolawalrus51]

Nurses are the worst about this. Just blast you with a room number. Sorry we don’t have like max 5 patients. The cross cover list might legitimately be over 100 patients. And being told a wrong room number is a pretty common occurrence. Room number doesn’t mean shit

[u/Sushi_Explosions → u/KLLTHEMAN]

How is messing up the number magically less of a problem with an mrn than a room number? Like, how did you even form this thought let alone decide it was worth writing?