Regional Samaritan Hospital; Kearney NE. After a long meeting of the IT department at RSH, Jay Koh, VP of Information Technology announced that new and creative ways of locking practitioners out of their EMR accounts are coming soon.

Elaborated, Jay Koh: “Our present schemes are clever, cruel and inflict meaningful annoyance to all EMR users. I mean locking you out after three unsuccessful attempts or forcing you to change passwords every week is solid. Requiring passwords with 12 unique characters, none of which is a vowel was brilliant. And the guy who decided to make you to use a different password for each of the 5 different applications got a raise. Did I mentioned that they all reset at different times? No, you may not use the same password from 10 years ago!”

However, continued Jay Koh, “We can do more. We can create more frustration. We can drive you into pure agony and torment as you get locked out at the start of your shift. We can make you utter expletives you didn’t even know existed while you’re on hold trying to reset you password. We can make you question the decency of the human institutions as you lose access during a code. Yes we can!”

While the full plan is still congealing, the IT people hinted at such intriguing ideas as permanently fixing keyboards in caps, requiring passwords to contain 85 characters, locking out after a single unsuccessful attempt or just using the middle finger emoji instead of a lock out message. Speculations floated that IT could get even more creative by moving the IT help desk to a country where no English is spoken. By the way, if you think that IT people sometimes change your password just to mess with you, you’re NOT incorrect.

At the time of the announcement ANA estimates that 15-20% of a nurse’s time is spent on logging in and resetting and updating passwords.

Kearney, NE – Seasoned floor nurses know and new nurses learn quickly: Figuring out whom to call for your patients can be a serious dilemma. In an effort to churn out nurses well prepared for the floor duty, Kearney Local Nursing College now offers a full semester course :“Who’s my patient’s doctor” Catalog number: WhoDa-eF2Ca11

There are many reasons to call a doctor: low potassium, high potassium, low blood pressure, high blood pressure, no blood pressure, chest pressure, abdominal pressure, pressure ulcers, peer pressure and constipation.

But, do you call the resident, the intern, the PA, the NP, the attending or his partner? Maybe his cross covering back up? Nope. He’s in on the golf course. Do you call the red team or blue team? Team C before 6pm, north team during lunch, night float at midnight and swing shift on Tuesdays and when raining. Is the patient covered by medicine, surgery, or by a thick layer of blankets? Do you page, call, overhead, or do a rain dance to get an answer?

Things get complicated and the course will teach such basic maneuvers as: asking the charge nurse and randomly opening the provider directory to page twelve. Checking the front of the chart or the back of the chart. Maybe its written deep in the middle of the chart or on the bathroom stall somewhere. More advanced techniques include calling a rapid response, pulling the fire alarm and faking own seizure just to get a few bodies in your vicinity.

Students completing WhoDa-eF2Ca11 may take an advanced course on such situations such as patients transferred without any report, patients that admit themselves, patients who’s aunt is also a nurse and patients that spontaneously materialize on the unit with systolics in the 60s.

In what should not be a surprise to anyone, the New England Journal of Medicine published a study confirming that patients admitted at the tail end of the night shift have lower diagnostic accuracy, increased morbidity, mortality and an extended length of stay. Lead author of the study, Dr. Fenton Neal further elaborated….”Yep sucks being the 16th or 18th patient admitted in a 12 hour shift. No big surprise there.”

In a further commentary, study co-author, Dr. Rocky Ronium noted that patients admitted at the end of the night tend to have “crummy differentials”, “sloppier handwriting”, “more coffee spills on the chart” and “increased use of expletives in documentation”

Examined late admission charts revealed such Diagnostic and Therapeutic Considerations as:

“Same thing as the last four guys” “Undifferentiated dyspnea”

“No clue… Hope the day team can figure this out”

“Cant believe they dumped one more on me”

“Some Rheum or ID thing…. maybe Tetanus.. Ebola”

“Didn’t we admit him with the same thing last week”

“Lets scan everything and see what lights up”

“I’m still three admissions behind”

and “The bar opens in twenty minutes”

Late admission outcomes were miserable enough to compare to those of patients’ admitted first week of July or over a 3 day weekend. Further sub-group analysis revealed that late admits’ survival approached zero if the day team did not get to them before noon.

The American Journal of Borderline Interesting Cardiology published today that a wandering atrial pacemaker has finally been settled in a permanent location. Dr. Amy Oderorone, project leader commented: “While not a serious medical condition, a wandering atrial pacemaker has been a nuisance to medical students residents and attendings….. everyone who’s not a cardiologist actually. Now this minor inconvenience has been solved.”

Dr Vera Pam-Mill who was also a part of the group went on to add, “It’s really not that serious of a diagnosis but the department forces us to do research, so why not settle this drifter.”

Dr. Brady Carr-Dick admitted that the settlement area between the third and fourth chin was not the most desirable location, but it provided an affordable home that is sparsely populated by other vital organs Reports indicate however, that the thyroid and both vagus nerves have become quite irritated by the presence of the vagrant pacemaker.

In an exclusive interview with Gomerblog, the pacemaker admitted that settling down was premature and he was planning to hit the road and seek new adventures shortly.  Non-cardiologists around the world can expect to be bugged by mildly abnormal EKGs soon enough.

In a joint conference, CDC and NASA delivered a striking blow to human ambition and ingenuity, announcing that MRSA has officially colonized Mars.  Defeating the dreams of such forward thinkers as Elon Musk and Richard Branson, aggressive MRSA became the first earth based organism to take hold of the Red Planet.

Infections Disease attending Dr. Emma Rassé informed the stunned audience of physicians and astronauts that MRSA can now routinely be detected in craters, rock formations as well as door handles and nursing homes of the red planet.

In a follow on announcement, ID specialist Dr. Anna Robes informed the deflated audience that resistant Pseudomonas has now taken a firm hold on the ,oon.  Venereal disease expert Dr. Estée Dee went on to add that multi-resistant gonorrhea was expected to be the first earth-based life form to leave the solar system.

The American Academy of Infections Diseases was divided on gonorrhea’s suitability to be the first contact of terrestrial life forms with alien races.  ICD-10 codes for bacterial colonization of distant worlds are expected shortly.

KEARNEY, NE – An operating room at Kind Samaritan Hospital (KSH) has entered a third week of shutdown as Anesthesia and Surgery continued to spar over their demands for the surgical drape wall. Both sides remain unwilling to compromise on any of their demands for the wall.

Anesthesiologists insists on a fortified construction with multiple reinforcing drape layers and drones to patrol the wall from above. They assert that such a powerful and tall structure is needed to contain the flow of undocumented body fluids, foul surgical language and illegal surgical elements emanating from the surgery side of the wall.

Surgery insists on a light and flexible structure, siting diversion of scarce drapes and clamps from unpredictable and rapidly changing conditions on the southern side of the wall. Location of the wall also remains a major issue as surgeons assert that the wall should abut the chin, allowing for a greater surgical field while anesthesiology insists on having access all the way to the cricoid cartilage.

Hospitalists’ attempt to mediate the conflict was unsuccessful and they had no idea where the Operating Room was and wandered on the loading dock. While both parties remain dug in, the patients at KSH are feeling the pain. Mr. Edward Dwindles, who’s ruptured AAA has gone untreated, has reported to Gomerblog that a solution is needed ASAP because having a systolic blood pressure of 60 for the last two weeks is really starting to suck.

HOUSTON, TX – The Great Texas Zoo had very high hopes for a newly installed $2M CT scanner. Local veterinarian Dr. Levi Quinn informed Gomerblog: “It was supposed to help us keep animals healthy by providing imaging to the biggest and most irregular of creatures. This thing can handle everything from a giant turtle to a slightly smaller turtle, to a lion and even a penguin.”

The celebration was short lived, however, as the news of the scanners arrival quickly spread to local human hospitals. CT scanners there are limited to 500lb and sending patient to the zoo has been a trusted way to get some pictures.

“Unbelievable!” Complained Dr. Quinn. This week we were planning to use the scanner to mate the last white rhinos in captivity. Instead we had to scan a 600lb man who got nauseous at the all you can eat Chinese buffet and a 550Lb woman who was more sleepy than usual. Turned out she confused her Diovan with Ativan and Celexa with Zyprexa.

“Our giraffe Shorty has been suffering from orthostatic hypotension for months!” continued the crushed veterinarian. “Instead of of helping him, we had a five hundred pounder alcoholic with belly pain. I could have told you she had pancreatitis without the damn scan!” The list of suffering animals includes a depressed tiger, an eagle with severe vertigo, an anemic buffalo and an impotent chimpanzee. The zoo is obliged, however to service the long line of human ambulances outside.

“Think of the animals!” implored Dr. Quinn. “Won’t someone think of the animals!”

KEARNEY, NE – Residency is full of minute details and keeping these all together is hard when you’re just starting out. So no surprise that brand new intern Katie Tonic at Kind Samaritan Hospital could not exactly recall if her patient’s Potassium was 4 or 14 during her very first rounds.

She had further difficulty reporting if he needed dialysis or had some paralysis and had to dig through the chart to see if her patient had Nocardia or Procardia. She was pretty sure that the patient was taking Zyprexa or Celexa or Ranexa and had some issues with his adnexa. He had an infected stoma or maybe worsening glaucoma.. perhaps an enlarging hematoma being invaded by a lymphoma. I think i’m going into a coma.

The patient was admitted to Urology with a Medicine consult, cause that can be a thing on your first day of residency. And Ophtho and Allergy consults would come any minute now. The patient would quit smoking and start a full exercise program immediately upon discharge.

He was either Full Code or Half Code or had a malignant lymph node. The patient was on normal saline and with a mutated gene and should be taking Thiamine. He was of-course allergic to morphine. But also to Tylenol, Aspirin, Norco, Apples, Bees and everything else that was not Dilaudid.

The next 12 months are sure to suck.