Efficiency in the ED

Practical EMS

Why does efficiency matter?

Beds are a limited commodity and the next patient that needs one might be dying

Mindset changes

Stop trying to diagnose. Try to rule out emergent diagnoses and determine if patient is safe or not safe to send home. Plan on negative work up before it comes back

Sick vs Not Sick

Not an innate skill. It’s learned over time and many patient contacts. Will help you determine dispo before the work up is back.

#1 See ambulance patients first

Potentially the sickest patient in the department. Need orders to be placed.

#2 ABD (Always be dispo’ing)

Discharge the patients that can go home and admit/consult those that need to stay or need a specialist BEFORE seeing new patients that have orders already placed.

#3 Run the board frequently

Should happen after each task that gets completed or new patient gets seen.

#4 Strategically plan non-emergent procedures

Laceration repairs can wait until you get caught up on more important tasks.
#5 Concise admission/consult requests

Few people want to read multiple paragraphs about why the patient is getting admitted. The reason should be clear enough to make concise.

#6 Chart as you go

Getting off late contributes to burnout and you should be signing charts with each disposition.
#7 Don’t repeat work that has already been done

If we are working as a team with a physician, you don’t need to repeat the HPI/PE, focus on following results and do the back end work like consults/admissions/reassessments and discharges.
#8 Show up like the day is going to be a complete disaster

You won’t be disappointed. Show up early because on-time is late. You should be looked up to by staff as the calm in the storm.

#9 Plan your exit early

Don’t sign up for patients in the last hour if you won’t be able to complete a dispo. Plan on which patients will need to be handed off to the next provider and have a CLEAR plan to make the next providers job easier.
#10 Use other providers as a resource

Use the experienced providers you work with as a quick source of education.

#11 Over communicate with ED staff

Nurses can help you out a lot if they know the plan. Delegating tasks is fine but as you get faster, it may be quicker to call lab, x-ray, CT yourself to clarify things are getting done and not lost in the shuffle.

#12 Place orders, than chart

If a patient doesn’t have orders in, the clock is ticking but nothing is getting done.

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