Tips to Improve Efficiency

Know your emergency department and staff, resources and limitations to flow.

Delegate tasks!

Its ok to say “I will get back to you, give me one second”. Finish tasks before moving on to the next.

Unless patients are crashing around you finish HPI, ROS and PE in chart, run your list and identify potential dispositions, if none click on red and move on to the next.

Order labs while in room with patient as well as fluid, pain control, anti-emetics etc. (sepsis alerts?).

When seeing the patient anticipate their final disposition, “if this then that” scenario. Communicate your reasoning with patient/patients family. They like knowing if there is a “possible admission” especially if they want to go home! Generally you will have a basic idea from the get go. Communicate plan for patient and to nurse. If they know the plan when you click ADMIT they will already know, saves a vocera call saying “patient did not know they were getting admitted.” This is always a rookie move and awkward.

Talk to consultants prior to talking to hospitalist, will save a step if hospitalist tries to defer to consultant.

“Doc my stools are dark/bloody” find a tech or nurse and finish rectal exam ASAP then get back to work flow. Same for anticipated pelvics. If thinking might be a pelvic related pain complaint do pelvic to try to differentiate. Otherwise CT abdomen and pelvis ordered simultaneously with pelvic ultrasound will improve throughput.

See patient as soon as possible get their workup started.

See patients “geographically” i.e. rooms 15-18….10-14…

If patient is crashing stabilize them and observe and then delegate tasks and move on to the burning department.

If you can maintain your interpersonal skills and type while in room with patient go for it. I always ask patients/family if they are OK with this first. I realized quickly this was actually slowing me down, but to each their own.

Learn how to do procedures RIGHT then learn how to do them FAST.

If the patient looks like an ultrasound IV/central line candidate DO THIS FIRST. Will save you time hours later when you are told no IV access and you are hours behind on patient care/final disposition. These can sometimes be your sickest patients as well.

Interns work on your learning, we do not expect you to move the department. Every shift push yourself to learn something new and become more efficient. You will see your list and efficiency grow as you become more knowledgeable.

“See one, dispo one”

Example of efficient management. See a migraine patient, give migraine cocktail, let nurse and patient know if feeling better pain score 2 or less may be discharged. Print their paperwork. Nurses should not be waiting on you for paperwork. You should be waiting on them.

If patient needs wound care (basic) this can be done by nursing if not understaffed, burning down department. Place nursing communication or use your voice .

If a lab will not change your final disposition for a patient but is pending, you can call hospitalist and let them know it is pending. They can still be admitted.

LISTEN TO YOUR PATIENTS, they will give you the answers.

Form relationships with patients and their families. Introduce yourself to everyone. They are vital to patients care.

ALWAYS ASK ABOUT SOCIAL/LIVING SITUATION! It is not fun to find out at dispo time patient is non ambulatory and lives at home alone. This is an important part of basic history.

URINE!!! If you know you will need it hand patient a urinal/cup and show them where bathroom is. If they need help with commode etc. or ambulation find a tech/nurse and let them know. This is often a rate limiting step.

If you have a general idea of what the imaging will show i.e. negative or labs finish your note and put *** in for pending information and finish your note, can go back at end of shift or quickly when results back for completion.