Felder/Chastain/A. Patel/Tekwani/DenOuden Panel Discussion Efficiency in the ED
Prior to Seeing the Patient
Before you see the patient, do a brief chart biopsy to identify their basic diagnoses and identify who their PMD is. Also, find the EKG before you see the patient.
Conversations with admitting physicians and consultants
When talking with consultants and admitting physicians, keep the conversations as brief as possible. Using perfect serve to text the initial info to the physician can be helpful. When you speak with an admitting doctor or consultant give them a brief synopsis of the case and give them what you think needs to be done during this admission. It may be helpful to keep a note of the patient's name, MR#, and one line on their case to be prepared when the consultant calls.
You only need to speak with a consultant if you have a clinical question that needs an answer acutely in the ED or if the patient has an acute management need from this consultant.
Many panelists commented on the excellent utility of Perfect Serve when contacting consultants and admitting physicians.
Interactions with Nurses and Techs
Make sure the nurse knows the plan and the to-do tasks for each patient so they can focus and streamline care as well.
Utilize the ED Techs to help you get tasks done.
Management of the Patient
Do your best to make a diagnostic plan and place orders all at one time and avoid adding on tests later.
Always be continually running your list to check what you can do to move patients along in the ED process. Always be alert to delays with labs and imaging. If you are always alert to where each patient is in their ED work up you can be ready to sign out at any time.
Put your discharge instructions right after you talk with the patient initially. That is the time when you will best recall your conversation with the patient and what your plan is.
Work to find the rate-limiting step for each patient and solve that rate-limiting step.
Interactions with Patients
Always ask the patient what they are worried about or what diagnosis they think they have. Most patients google their symptoms and have preconceived concerns about what they have going on. If you can specifically address their concern, you have a better chance to achieve higher satisfaction.
One strategy to end the conversation with the patient is "I am going to step out now and order your tests and get your work up started. I will be back to check on you later."
Another closing strategy is to summarize with the patient what you perceive their diagnostic problem is how you are going to work it up, what the treatment plan in the ED will be, and what the likely dispo will be.
Schmitz Safety Lecture Sepsis
For the entire Advocate System, mortality for sepsis has decreased by close to 25% between 2015 and 2017!
Advocate is starting to gather data on patients that were seen as outpatients within 72 hours of an ED visit for sepsis. The system is trying to find ways to earlier identify infections that can develop into sepsis.
Schroff 5 Slide Follow Up
Subclavian Steal Because of a stenotic subclavian artery, exercise with the affected (left) arm steals flow from the vertebral artery which can result in syncope or neurologic symptoms.
Hart/Regan Ortho Cases
EM Boards Classics: Montaggia and Galeazzi fracture dislocations. You gotta know these. Montaggia is fracture of the proximal ulna with dislocation of the radial head. Galeazzi is fracture of the distal radius with dislocation of the radio-ulnar joint.
This is a distal biceps tendon rupture. The muscle is bunched up superiorly. The proximal bicep tendon can also rupture and result in the muscle bunching up inferiorly
Best Conference Attendance for the Year
#1 Jeff Florek #2 Anita Schroff#3 Jenny Denk
Congrats to Jeff, Anita, and Jenny!!! Outstanding effort this year!!!!!
Garrett-Hauser Ethics
Steps to taking custody of a child: #1 Call the Hospital Administrator to notify them. #2 Call DCFS #3 Discuss with the parent. You may need security on hand when you have this conversation. These are very high risk situations. Utilize all your hospital resources: risk management, chaplain, security, nursing, and if needed, the police.
How do you change the code status for wards of the state? The most straight forward way is to call the phone number of the patient's guardian listed on their paperwork and and discuss the management of the patient with the guardian.
For developmentally delayed patients who are not kids or elders and have a need for placement in a NH or safe environment, utilize the care managers. They have the skill set to get the patient placed in a safe environment. PLOWS is the state agency that helps to place adult patients who do not fit into the pediatric or elderly categories.
Regan and Alexander The Last Lecture
Very clever, heart-warming, and funny reminiscing of the Class of 2017.
ALL the BEST to the Class of 2017!