Atrial fibrillation Doctoring Health Care Reform

I confess: mindless medical forms and I do not get along…

It’s official.

It now takes longer to do all the necessary forms, than to do a simple cardiac procedure, like a cardio-version. Seeing the patient, administering a sedative, and delivering a synchronized shock that converts AF to regular rhythm takes just a few minutes.

However, in 2010 (in all hospitals), the number of forms has grown like a Kentuckian’s belly.  There is the History and Physical which has to be updated, even if I saw the patient that morning in my office.  There are two consent forms.  Not sure why there are two, I stopped asking a long time ago.  The medicine reconciliation sheet which includes all medicines, even ginko biloba, and the like, has to be checked and signed.  

The king of all forms though, is the sedation form.  This scary form has evolved, and now devolved, at the whim of what the hospital surveyors say it should be. The right words change all the time.  Sedation seems to be on our watch list presently. Even the timing of the pre-procedure assessment has come under close surveillance. An arbitrary window of time exists between when I should have assessed the patient, and when sedation is delivered.  I am not sure the exact number of minutes, but I am pretty sure the patients neck isn’t getting any fatter in any number of minutes. Thankfully, there is usually a stickie note telling me what time to write in.  

Please do not think my disclosure of silliness is a marker of carelessness.  I, and my experienced EP lab staff do think of sedation issues.  We simply do not have problems with sedation.  As close to never as imaginable. We are really good at it, and the comfort of our patients during and after the procedure is a source of pride. The administrator-laden forms would suggest I am a medical student, but after administering sedation for years, I know my limitations.  The anesthesiologists reside right around the corner.  For the “biggie-chair” people we get help.

The new sedation form asks: “Plan for sedation.”

I really do not know the present-day–but sure to change soon–politically correct words to answer this simple question. Neither do my experienced EP nurses.  Just for grins, I surveyed them today.  “It’s conscious sedation,” one said.  The other, “no, it’s moderate sedation.”

Ok, it’s settled.  I know what to write on the form.

Plan for sedation:  “The same as I have done for the past fifteen years.”  Or, “just the right amount.”

We will see how this goes.

Environmentally speaking, green is not the color of medical documentation in this new era of protocols and forms.

“Time out.”