Little Things

Nurses are on the mind these days -- for the first time in its 18 months, Grand Rounds has nurses as back-to-back hosts. Last week was Emergiblog, this week is GeekNurse.

It's got me thinking -- I'm pretty lucky to be working in hospitals offering some of the city's best nursing. Not being required to start my own IVs, or print labels, or push many meds, really frees up my time to see more patients, which is really what I ought to be doing.

I've written before about reporting respiratory rates -- how nurses (and EMS, I gather) often just report "20 breaths per minute" when a patient appears to be breathing comfortably.

There are a few cases where that's dangerous -- such as, for instance, when the respiratory rate is actually 20.

I've noticed that our ED's nurses, when they want to bring to my attention a patient's tachypnea, actually record "19" or "21" as the respiratory rate ... It's like they're sending me a secret code through the vitals that not all is well. Sometimes, when things are busy, this can be our only interaction -- so it's particularly sly and efficient.