Changing T to L Number

When working as the charge resident on the T day in either the “Accident Room” or “West Admit”, I was responsible for managing all patients that clocked in at the triage nurse between 7 AM at the beginning of the T day until 7 AM the next morning at which time all admits were assigned an L number.  Then it would repeat itself for 24 hours until the next Tulane day the following morning.  As the charge resident, that meant that if a patient checked in at 6:59 AM and was assigned a T number, I had to stay until the disposition of that patient was finalized from the emergency room.  That meant that the workup had to be completed, including all labs, x-rays, and the patient was either admitted, went to surgery, or went home.  This was exclusive of having to go to “Pus Clinic” each morning after my 24 hour shift during weekdays.  It was not uncommon to still have a patient in the emergency room that I was responsible for until long in the afternoon, before I could go home.  This made for a short period of time to catch up on sleep, see family, and take care of things at home before I had to return to Charity for my next 24-hour stint at 7 AM.

I started running interference when it got close to 7:00 am, near the end of my shift in the Accident Room or West Admit.  Starting about 5:30 am I would keep an eye out for patients heading toward the triage nurse’s desk.  I would stop them and ask “what was the matter.”  If it was abdominal pain, I would fill out a radiology request form for a flat and upright abdominal x-ray and tell them to go to the 7th floor to get their s-ray first and therefore save time.  It usually delayed them long enough so that by the time they got back with their x-ray and checked in with the triage nurse it was after 7:00 am and thus not my problem.  I was able to do this for chest problems by sending them for chest x-ray, x-ray of ankle or hand it pain involved those areas.  I had less late patients and go home sooner doing that.

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