I read the article, “Like Cats, ED Computers Are Moody and Fickle,” by Stacy Harmon, MD, and laughed out loud for a good two minutes. (EMN. 2021;43:23; https://bit.ly/3BEJtHQ.) I then shared it with the providers and nurses in my small emergency department. It is so true!
I'd like to give two other examples of increasing our workload to save someone else time and money. We were reassured that we wouldn't have to do anything related to coding and billing, but in some hospitals I've worked, I've been expected to put in the computer not only verbal orders given in cardiac arrests or other emergencies, but also those for medicines that I pull from the Pyxis myself, such as lidocaine. When I reminded the administration at a previous hospital where I worked that an order is a means of communication from a provider to a nurse to do something, which should be unnecessary because I don't need to communicate to myself, I was told that for billing purposes the order needed to be in the computer.
I pointed out that someone must be aware the medicine was missing from the Pyxis because if there is no such order, we are told that it was removed from Pyxis and asked to enter an order. I was then told that the coders/billers didn't look at the Pyxis inventory, only at the EMR orders. I'm so glad that the provider is able to save the coder/biller time and money and make their job easier by doing it myself.
Another example is the process for ordering COVID tests. We need to answer questions such as is the patient pregnant, is the patient admitted, is the patient in the ICU? Instead of having the IT people program an if/then statement (If patient male, pregnancy is no; if patient is female and <9 or >50, then pregnancy is no; if patient admitted is no, then ICU is no), we have to answer the questions on every patient. To make matters worse, we also had to fill out a paper order with the exact same information. It took six months to get rid of that onerous process, but in the ED where I currently work, the nurses have to fill out that form.
Mike Antoniello, MD