Patient dumping at handover

Case: 75Y F, worsening chronic low back pain. Had 2 tablets of Endone before presenting to ED @ 2PM; Seen & given Targen 10/5mg & Valium @ 4:40PM; Reviewed & given Target 15/7.5mg & Palexia IR 50mg @ 10:45PM; Handed over at 11PM for further review, aiming for discharge home. It is an unreasonable expectation for our overnight ED doctors to send home an elderly patient loaded with narcotics and benzodiazepines in the middle of the night from our private ED.

There will be differing approaches in this case. It is, however, expected that a FACEM would be able to formulate a clear management plan at the conclusion of the initial consult; set an end point for the review at hours after the initial treatment/medication, i.e discharge or admission should the patient fail to improve. Repeated reviews without a clear end point is not an acceptable ED practice. It is not fair for other doctors to deal with the issues after the patient had been with us in ED for 8-9 hours. From your feedback, similar cases like this happen often during the handovers at 3:30PM and 11PM.

It is reasonable to expect a FACEM would make a proper disposition plan within 2-3 hours after seeing a patient, definitely after 5-6 hours. Leaving an untidy end to your colleague should be exception only. No one likes to have a handover with a lot of loose ends. Please don’t do this to your colleagues.

CT report delay should not be used as an excuse for no decision as the reporting room of radiology department is an easy walking distance. Our radiologists are always happy to give us a verbal report if the CT scan is completed.

BTW, if the patient is handed over as an admitted patient, please make sure the medical notes and drug charts are properly completed.