r/emergencymedicine • u/Icy_Strategy_140 ED Attending • 2d ago
Discussion ED Attendings, share your best workflow advice
ED attendings: what’s your most underrated workflow tip(s) that genuinely made you better/faster/saner in the ED?
Not generic advice. I want the oddly specific stuff you only learn after years of shifts. Mental tricks, charting habits, dispo shortcuts, patient management, consultant hacks, avoiding getting buried, etc.
What actually changed your practice?
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u/Corgi_DadimusPrime 2d ago
If you must dictate an ECG do not touch it twice. Sign it, dictate it, send it to scan. Those papers are impossible to find at end of shift.
Procedures - numb them, walk away to do something else (see another patient?) and then come back.
Train your hospitalists to use Epic chat for admissions rather than playing phone tag.
Consult once imaging labs etc is back for stable patients.
Batch new patients, I usually see 2-3 at a time and put orders in while I'm talking to them in the room. More FaceTime for them and you are less likely to be interrupted if you are in the room than at your desk.
Wet read your own images, dont wait for a radiologist to call you for free air, ptx, ich, kidney stone etc. If you can find it by reviewing the image yourself you can act on it. And no i still can't reliably find the appendix after 10 years in practice.
1 tip though - talk to your nurses and techs. If youre generally NTA they will do as much as they can to streamline things for you.
Curious for others thoughts too
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u/the_silent_redditor 2d ago
tip though - talk to your nurses and techs. If youre generally NTA they will do as much as they can to streamline things for you.
Yeah, be nice.
It’s not hard.
Nurses / clerks / techs are still shocked when I include them in the coffee run.
Be collegiate and kind and present and it will be reciprocated ten fold, and you need them to be nicer to you more than the other way around.
I still deal with doctors who are total cunts to me as the referring/in-charge doc who has more experience than whoever I’m speaking to. That shitty attitude is often even worse to colleagues ‘lower’ in the hierarchy, and hits ten-fold. When a doc is a cunt to me on the phone I just laugh it off and move on with my day; it can truly ruin the day or week of nurses/techs/cleaners/whatever.
Don’t be a dick. It’s not hard. If you’re not a dick, life is so much easier.
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u/Corgi_DadimusPrime 2d ago
You'd think its not hard, but the job can be stressful and manners slip. The tech is not trying to ruin your day by handing you an EKG, they're just required to do it within 5 minutes of performing it.
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u/the_silent_redditor 1d ago
Yeah I mean I get it.
I used to be IC of a very busy metro hospital. Wouldn’t be uncommon for me to have 70 people in the waiting room, all waiting to be seen; 160+ in the dept; resus full of unbelievably sick people and I’d have to sign off every ECG and gas and manage a team of very junior medics, some with barely any crit care experience.
The occasional snap is inevitable. Sometimes you have to take a 2 min walk to the bathroom.. even then I’ve had nurses following me with an ECG.. like come on lol. Or trying to ask me to chart when I’m literally on two phones at once. Painful.
But, on the whole, try be nice I guess.
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u/yurbanastripe ED Attending 2d ago
I’ll second the epic chat feature, coming from residency where I had to make a physical phone call for every single consult and also admit (which includes waiting on the phone for the operator to connect you, playing phone tag, etc) versus where I work now as an attending I use epic chat for 95% of my consults and admits communications and it has improved my quality of life drastically
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u/Dr_Geppetto ED Attending 2d ago
Don’t leave the room until you fully understand the complaint in the context of the patient and have a crystal clear idea of their disposition. Most novices order a bunch of random tests based on the chief complaint alone, feel pressured to move on to the next waiting patient, and then, when the results come back, realize they have no clear understanding of what they are actually doing with the patient.
If you feel the pull to leave the room and see the next patient, but you still do not fully understand the patient in front of you, sit your ass down and keep asking questions until you know exactly what you are doing. This will save you an enormous amount of time on the back end and improve your efficiency more than almost anything else.
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u/nateisnotadoctor ED Attending 2d ago
If you are about to get trapped in the middle between two consultants arguing about whether this is GI or gen surg, or a consultant and a hospitalist about who should be primary - whatever - start an epic chat between the three of you and say "let me know when you guys sort out an agreement" and walk away. If they don't respond to the epic chat do the exact same thing with a 3 way call and then hang up once they're connected.
Don't be other people's secretary. If you let them treat you like one they will use you like one.
Similarly; use the phone as little as humanly possible, which is already going to be a lot. If someone has to call the family or nursing home, get the nurse to do it. If someone is asking you to do a nonphysician task, ask yourself if you actually have time to do it. If you do and want to be a nice guy/girl of course go for it - team sport yadda yadda - but never forget that your skills are best applied to doing physician tasks not other stuff.
edited to add: you get to decide what stuff you care about and what stuff you dont. For example, I honestly, 100% do not care about social or psych issues in the ED (obviously I care as a human but I don't have time for that at work). My job for those cases is to clear them medically. I will refuse to have conversations about placement with family, social work issues, case management issues... whatever. We have a terrific social worker who helps with that.
I've worked at some ERs where the docs did way too much as a matter of culture and the other staff truthfully did not do much. they were not high functioning ERs.
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u/HappilySisyphus_ ED Attending 2d ago edited 2d ago
I explain everything during my first contact with the patient. I tell them what’s gonna happen and how if I don’t find anything concerning, I’ll put their discharge in and if they have any questions, they can ask the nurse when they bring them their paperwork and if needed I’m happy to return.
I tell them I’m ordering a dimer and if it’s positive someone will get you for CT and if that’s negative, you’ll go home.
Or how I’m trending troponins and if everything looks OK I’ll make sure they’re OK to go to the observation unit for AM stress test.
Etc. etc.
Saves a lot of back and forth.
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u/procrast1natrix ED Attending 2d ago
Yaasssss.
Have a good solid exam and interview, and then spell out the next steps.
"All this vomiting looks miserable. I'm going to order antiemetic and fluids, and because your kidneys have been touchy in the past we will get some screening labs to look for electrolyte issues or kidney injury. In about an hour, the nurse or tech will pop by with some ginger ale, which I caution you to drink very slowly at first. IF the labs look fine, and the soda goes well, then some crackers, I'll send a script for the nausea meds to your pharmacy and you won't see me again, the nurse will bring your papers and work excuse. Practice careful handwashing and follow-up with your PCP. IF the labs are concerning or if a dose or two of the nausea medication doesn't work, I'll come back and we will make another plan. Sound good?"
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u/Necessary_Web_8717 2d ago
I think this is so important. The biggest workflow disruptions are patient questions, family updates, “why am I getting XYZ”. If you can foreshadow the visit, wait times, when you’ll return that helps. And communicating plan with nurse helps prioritize tasks for them, especially if “this is a nonemergent patient, once they get this we can discharge”. Helps dispo times by probably 45 mins at my shop
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u/GCS_dropping_rapidly 1d ago
As an a&e nurse <3 <3
Plans. Plans. Plans. Plans. Give. Me. The. Plan.
Plannssssssss!
I can manage the rest. As long as I have your plan!!
If I have the plan I can deflect like 99.9% of the questions, interruptions, conversations, complaints, pushback, phone calls...
If I dont have a plan I cant do shit
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u/cheesewilliams 2d ago
- I see a patient then immediately write the HPI, physical exam, and start the MDM. I have dot phrases for certain physical exams (like a general trauma exam, neuro exam) where I write everything as negative and will change anything that is positive.
- I've slowly created a bunch of dot phrases for each general chief complaint (ie. chest pain, dyspnea, general abdominal pain). In there I discuss a broad differential how I ruled them out. If anything happens to be positive I just delete that portion.
- If I have my name on a bunch of patients and a new patient pops up, I'll sign up for them but then go through each of the patients I've already seen and update my note with anything new (labs/imaging results/consultant conversations) before I go see the new one.
- Before I dispo a patient I finish the note. This way you don't get stuck with a bunch of notes at the end of your shift and it also helps you double check everything. I've caught a lot of mistakes this ways.
- I also have dot phrases for discharge instructions for the most common things.
All of these and the dot phrases are small things, but overall it adds up.
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u/metforminforevery1 ED Attending 1d ago
My two most common dot phrases for MDMs are chest pain and MSK pain because I feel like I see at least 5 of each of those a shift, and they're negative 95% of the time.
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u/Kindly_Honeydew3432 2d ago
If a patient can be dispo’d and no one is dying, dispo the patient before you do anything else, period. Even if there are twelve to be seen. And 50 in the waiting room. Turn the room over.
There are a lot of patients that you can see once and never go back into the room. Maximize all these opportunities. I often have my followup/return precautions/care plan with the patient at the same time as my initial encounter. I tell them, I strongly suspect you have x going on, in which case I will treat you with y, and recommend that you z. I’m going to order these tests just to be complete and make sure we’re not missing something important. If everything comes back as expected, I’m going to go ahead and have the nurse release you and go over your results. But if anything unexpected turns up or if you just have further questions, I’ll be back in personally. 90% of the time I never have to set foot back in the room, and it also often identifies those “oh by the way” concerns that often come up at time of discharge.
Figure out what tests are useless 98% of the time. Try not to order them. There is nothing worse than waiting two hours for a patient with musculoskeletal back pain to pee when we all know it’s not a UTI.
Intravenous interventiona oftenturn into the nurse in the room for 20 minutes , ignoring your other patients only to ultimately come tell you that someone else, maybe you, has to go do it. It’s a huge drain on patient flow. If they don’t need an IV, don’t order one. You have copious oral, SC, IM, topical options for most things. Use them when you can. Talk to the patient about why. (This may save you more an hour or more in the ER and potentially a lot of discomfort, and honestly it’s not necessary and no more effective. If they buck, fine. Most of the time they’re all about it.
Try to find out up front what the patients expectations are regarding admission. Don’t chase a bunch of tests that you’re only offering to appease the hospitalist if the little old lady with syncope has no intention of letting you admit her anyway.
If you’re considering ordering a test or intervention just to appease a patient, that’s fine. But diplomatically tell the patient that up front. You’ll be surprised how often they decline.
If you have a chronic opioid seeking patient, be up front with them the second you walk into the room what you’re willing to do and what you’re not willing to do. They will often decide to seek a second opinion elsewhere rather than occupy your bed for three hours waiting for CYA tests.
Treat your consultants respectfully and be considerate when you call them. But be firm when you need them to do the right thing for the patient
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u/MathforMarines 2d ago
As an ED nurse, thank you for that first point of turning the room over!
A few of our providers will sit on patients until the end of their shift, then suddenly a quarter of the department is up for discharge. Especially sucks when two end their shifts around the same time lol. the nurses discharge, flip, and settle the next patients so our work load will spike at these times.
I won’t pretend to fully grasp your guys’ flow, but we definitely notice which providers get stuck in this cycle. I have also noticed the docs who do this routinely leave late as they try to wrap up all the dispos.
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u/Danskoesterreich ED Attending 2d ago
Work like a rheumatologist treating rheumatoid arthritis, "hit early, hit hard": see a lot of new patients in the start of the shift and then transition slowly to only follow-up, discharge, and coffee breaks.
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u/Rhizobactin ED Attending 1d ago
Or the incredible inefficient process of “ I just wanted to see if Tylenol worked first before I started anything else”.
Jfc. Hit them hard with everything you like to use and make them comfortable. Not apneic, but don’t piecemeal - order diagnostics AND therapeutics.
Nothing sucks more than getting a sign out only to realize that no therapeutics were ever administered. Five hours later, the patient’s asking what to do about their headache that they haven’t gotten absolutely anything for.
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u/ErgogenicDiet ED Attending 2d ago
If you find yourself documenting something or ordering something twice on shift, automate it with a dot phrase, dragon auto-text/step-by-step command, and/or order set.
Agree with others who state doing notes once immediately after seeing them and then signing right after dispo.
If you anticipate a procedure, prep for it out of the gate with lido, all necessary equipment, etc. Best time to do a procedure was an hour ago, second best time is now.
Order of operations is Emergencies > dispos > procedures > notes > new patients > following up on existing patients.
there are three dispos from the ED: home, hospital, morgue. Figure out from the outset what information will change the dispo so that you are not developing a plan In response to individual results as they trickle in. e.g. lactic normal? Time to dispo. Understanding these branch points a priori will speed up your dispos and clarify your plan of care. If you anticipate discharge, prep papers at time of writing the initial note.
When reaching out to admitting/consulting providers, structure your messaging to spoon feed them. Reason for Admit: X. Level of Care: Y, HPI: Z, Pending: N/A. Callback: 555-555-5555. For consults, include a clinical question, preferably as a binary where you imply your desired outcome (e.g. given SBO on CT, would you recommend NGT and admission?)
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u/jeremyvoros ED Attending 2d ago
“Order of operations is Emergencies > dispos > procedures > notes > new patients > following up on existing patients.”
This x1000.
Discharging and ankle sprain patient may seem less important than seeing then new ambulance patient that just arrived. But that’s the wrong order.
When you let the patient sit that bed is full, they have questions for the nurse, or they need the bathroom, or their family member wants a phone charge. The longer they are in a bed, the more work the department does.
On the flip side, unless that ambulance patient is crashing, your team knows what to do. They are getting vitals, changing the patient in to a gown, starting a line, doing an ECG. That will happen whether you are there or not.
Go dispo the low acuity patient, open a bed, stop the work that patient is creating. Also it means you get them out 10-15 minutes sooner. Meanwhile the ambulance patient is going to be in your department for hours no matter which task you do first.
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u/DadBods96 2d ago
Discharging patients with micro results pending; STDs, viral swabs, shit tests (although this is actually how I cure the patient, I’ve not had one change management outside of C Dif). I used to hold onto them for hours only for me to not act on the result at all.
Not only does it rarely change whether I’m prescribing something or not, but other than viral swabs, there is typically someone on day shift who has it included in their job duties to call patients back and send in a script for all micro results from the last 24-48 hours.
Especially for STDs, you’re either treating empirically from the start based on history +/- exam, or you’re waiting for the results, you shouldn’t be waiting for results then deciding to treat anyways.
Similar for x-ray results, especially outside business hours where this can be a 3-4 hour wait for an ankle plain film. If I don’t see a fracture and I’m calling it a sprain, I’m likely giving the patient a semi-immobilizing device such as removable wrist brace, thumb spica, ealking boot, etc. already (seeing as urgent-care level MSK visits seem to universally be big babies at baseline just to think they need to be in the ED in the first place), and discharging. On the off chance there ends up being a fracture, they get a call back and instructions to go to whichever place they’d like (PCP, urgent care, back to my ED) and have a splint placed. This one requires two things though; 1) The ability to accurately interpret a plain film, and 2) The patient has to be agreeable with coming back without throwing a fit about how stupid I am in the 1/20 chance that I missed a fracture.
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u/metforminforevery1 ED Attending 1d ago
coming back without throwing a fit about how stupid I am in the 1/20 chance that I missed a fracture.
I give the pts the option of waiting for the official read but tell them they're gonna wait in the waiting room for it so we can use the space. Most of them would rather go home and get called back if we're wrong. Usually as long as they get an XR and some pre-fab splint/boot they're pretty happy regardless.
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u/Acceptable_Reply7958 1d ago
See a patient, write the note. Never deviate unless there's a code. Use whatever voice-to-text works. Don't stay late to write notes. Get good at nerve blocks.
Develop good relationships with your consultants. None of this "fuck them, they're on call, they get paid to do this". They're human beings you work with and everyone's life will be better if they respect you and you respect them.
Develop good relationships with your RN's and techs.
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u/tuagirlsonekupp 2d ago
Still a resident, but I will see 2 to 3 patients complete their note through the MDM, start the MDM and then keep picking up that way. When I’m disowning them I just touch up the MDM and then keep going. Keep my notes done on time so I can leave on time.
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u/parasympathy 1d ago
My biggest game-changer was tying documenting to putting in orders. I never go home late, never leave notes for home, and am still at the top of my group in pph.
My second biggest was badging into the computer in the room as I introduce myself. I can often put in orders, look at & document the CXR, start the dispo while the patient talks, especially for the long-winded ones.
Learning what's actually important to document helps a lot. My notes are generally short, but they communicate the important things and they hit all the necessities for billing.
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u/amiguel 2d ago
After taking history and physical exam, tell the patient and his family that the main objectives are: 1) Make sure they are not dying by excluding vary bad diagnoses 2) Take care of the main symptom(s) that brought them here 3) Setting expectations on discharge / hospitalization time.
“We are not always going to find the exact diagnosis but I’ll make sure you are not dying and will work to take care of your symptoms. After that you’re either coming in or going home, and me or my team will let you know as soon as we know.” Or something like that….
I think that patients knowing what’s going on and setting expectations make dispos easier.
Just my 2 cents…
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u/ExtremisEleven ED Resident 20h ago
I make sure to say “make your [presenting symptom] tolerable”. I got tied to the understood promise that I would resolved someone’s pain once and now I’m quick to tell them that I might not be able to resolve it, but we will at least make it something they can deal with or they get admitted.
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u/Kindly_Honeydew3432 2d ago
I thought of another one. If you are forced to order that test that you know is going to be negative or not change your management much on a vertical patient, don’t wait for the test to discharge them. Tell them you’ll call them if it’s positive. Or better yet, that they can follow-up themselves on mychart.
“I think little Timmy may have a viral throat infection. But it’s possible it could be strep. Sometimes we get busy and it takes an hour or more to get the result, so I am going to go ahead and discharge you , and if it comes back positive, I’ll send antibiotics to your pharmacy. Where would you like me to send the prescription if needed?”
The same kind of conversation can be had for flu/covid, many x rays. Yes, these tests may only take half an hour. But sometimes things happen and they turn into and hour and a half. Or that patient turns into the neediest person in the world and you get called back into the room 5 times for various reasons. Not to mention bed turnover.
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u/RhinoKart 2d ago
God I would love if our doctors did this.
Instead I'm fielding questions for hours after a patient could have been discharged about when the doctor will come back (who if course has gotten stuck in resus) and I have my charge nurse calling me every 15 min to see if the room can be turned over yet.
Meanwhile all the patient needed was a script for PO amoxicillin.
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u/Rhizobactin ED Attending 1d ago
And unless the patient is actively dying in front of you, if it’s trauma or stroke alert, you have time to glance for 30 seconds to review vital signs, triage notes, past diagnoses within the EHR, med list and allergies.
After years of working with residents, I’m always completely baffled how a more senior resident will see a patient get back and present the patient only to have me ask the most basic fundamental very critical past medical history-related question and they didn’t even know that the patient had it “well, they said they didn’t have any other pmhx”.
The way I trained was that you either read the triage note now or you read it in front of a jury. Assume that complex past medical history exists, and you are responsible to recognize the risk factors with those as well as the medication‘s associated with that.
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u/amickdee 1d ago
Good stuff. I'll add that a constantly updated brief plan for each patient on the EMR track board updated each time I sit down and run the list (example: EKG/XR/trops>dc, or CT+suture>dc) prevents a lot of unnecessary nursing questions and helps me cognitively offload long patient lists.
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u/newaccount1253467 2d ago
If you are 99% confident on discharge after results for easy things, tell the patient during the first and only time you see them.
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u/Loud-Bee6673 ED Attending 1d ago
Honestly it depends on you and how you work best. There is some very good advice in this thread, including dot phrases, completing H&P (and sometimes MDM) immediately after seeing your patient. Or patients if you batch them. If you know what if going to happen, you can even write discharge instructions at the time you chart everything else.
The bottom line though is that you won’t know what works best for you until you try a few things. It depends on your acuity, your volume, your population, and your consultants.
If you work at a place where you get a lot of pushback, you need to factor that into your flow. If you frequently get disputes as to who needs to handle a patient, don’t wait until you have called each of them several times. You third call is on a recorded line with both of them (I use the transfer center at my facility, they will get both consultants on the call for me.
Hopefully by the end of residency you have a pretty good example of what works best for you. Establishing some consistent habits really does save you time.
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u/jenivalda ED Attending 2d ago
Prioritize the dispo and do the work for the discharge/admission before seeing the next patient.
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u/RandomHero117 2d ago
Towards the end of your shift, prioritize getting orders in early especially for ct and such. Last 2 hours of shift I make sure I get workups going then I’ll discharge the people who are ready
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u/Admirable-Cloud-9964 2d ago
When I was a resident one of my attendings told me to treat discharges like STEMIs. Get them out ASAP. One of the best uses of your time is aggressively dispoing patients to keep the department flowing. Priority 1: stabilize critical patients Priority 2: dispo existing patients Don't be the doc who sits on dozens of patients and doesnt dispo until the end of shift. Your nurses and colleagues will love you for keeping a clean department.
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u/metforminforevery1 ED Attending 1d ago
Lots of good advice here, but another little thing I do that helps a lot is when I'm opening up their note and starting their HPI/PE and MDM, I pretty universally give them a diagnosis (abdominal pain, ankle pain, etc), and then send a prescription to the pharmacy that I just asked them about (for the pts getting one). That way I don't have to circle back "Which pharmacy was it?" It saves like a minute per pt, and when you're seeing 30pts in a shift, that adds up.
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u/phattyh 1d ago
In patients who don’t have a specific diagnosis and work up is negative - I tell them how long I’m working for and tell them to call back the ER if they have any follow up questions and that they should request to speak directly to me. If I’m working the next day I will tell them when and the times to call back if they aren’t feeling well.
I have found this diffuses a lot of situations and also gives reassurance that I’m not blowing them off. And it makes discharging patients much easier as well. In 10 years I’ve had less than 5 patients call me back. But I think all my patients have appreciated it.
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u/Useful-Country4755 2d ago
1st: Is anybody about to die? Stop them
2nd: Can I discharge or admit anybody at this exact minute?
3rd: Put in orders/See new patient
4th: Write a note
Do not allow patients to accumulate. Dispo immediately unless somebody is dying.
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u/jus-being-honest 2d ago
Try to bundle as many tasks as possible. I try to get out of my chair as few times as possible as a game in my head. When I do get up I map out the order I’m going to do all of these tasks so my walking through the department is as efficient as possible
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u/jeremyvoros ED Attending 2d ago
Tell your patients what to expect from the first contact - workup and timeline. This will save so many headaches later.
- Ok so we are doing blood work and urine tests. We are checking your kidney function, white blood cell count and looking for urinary tract infection. Your labs will take about 40-45 minutes and then you will go for a CT scan. I will have your CT results about 90 minutes after than. So you’ll probably lay be here at least 2.5-3 hours.
- Ok we are getting an xray to see if your ankle is broken. I suspect it is just sprained. So if there is no fracture the nurse will bring in a splint for you and we will send you home with you doing ibuprofen, Tylenol and ice for a couple days with a note to stay home from work. If it’s broke. I’ll come apply a splint with the nurse.
I promise if you can do this kind of thing with 90% of your patients you will notice a difference in the number of questions and interruptions you have.
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u/sotirEDofmedicine ED Attending 1d ago
If you are at a place with overlap, do not yap for your last hour. Your last hour is your hour to chart and catch up. Turn off the social brain and DICTATE.
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u/-ThreeHeadedMonkey- 1d ago
Patient needs ultrasound? I'll go in with the US from minute 1.
History done during the ultrasound etc.
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u/G3ntlereli3f19 1d ago
Batch your charting by dumping the objective data and physical exam findings the second you step out of the room instead of waiting until the end of the shift. If you have to spend more than thirty seconds thinking about what you saw later, you have already lost the efficiency battle.
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u/mumbocolumbo 1d ago
I often hear different strategies on prioritizing dispo vs seeing a new patient. My answer? It depends. Of course ;)
At the start of my shift I prioritize dispo-it helps get more rooms open and get those newly roomed patients seen sooner.
Towards the end of my shift I prioritize seeing new patients. This is somewhat selfish but it helps me get out on time which massively reduces burnout. and I can just put in orders on the patients who will be seen by the next doc.
What if you’re bogged down in the middle of a busy shift with 3 patients to dispo and 3 patients to be seen? I prioritize seeing the new patient with the least obvious workup first. So if a 75M chest pain, 23F pregnant vaginal bleeder and 48M leg pain get roomed at the same time, I’m entering orders on the chest pain and the vaginal bleeder and I’ll see them later. 48M with leg pain could be anything-minor trauma? Order X rays. Unilateral leg swelling? US with labs/coags. Painful hot rash? Oral abx and home. You get the idea. The chest pain and vaginal bleed patients are gonna get the same workup you’d expect no matter what so go ahead and get those cooking. But there are many ways a “leg pain” visit can go in my experience haha. This can help prevent serial workups which are an efficiency killer.
Once I’ve seen the “uncertain workup” patient then I see one/dispo one usually in order of length of stay. Rinse and repeat until shift end.
It goes without saying but if anyone in the ED is unstable they get seen first!
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u/skywayz ED Attending 15h ago
There is a lot of good advice here, but one thing that hasn't been mentioned is take just 60 seconds after signing up for a stable patient to do a chart review. Note this really only works in Epic, as other EMRs this is far harder to navigate.
For my chart review I do the following: 1. Glance for any ER/UC visits in the last month including care everywhere, skim it 2. Skim most recent discharge summary if less than 1 year old 3. Skim meds 4. If chief complaint is cardiac in nature, review EF, last stress/cath
This usually takes about 2 minutes, but it adds a lot of value. I find patient's like that you know this information before you even go to see them for the firs time, it also allows you to fill in a lot of blanks in the HPI.
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u/E5D5 PEM Attending 2d ago
See a patient, then sit your butt down and put your HPI and physical exam into the chart before you see another (true emergencies notwithstanding obviously). MDM if you can, but I find that easier to put in later if I have to. The worst shifts are the ones you get wrecked and have a couple dozen blank charts to finish at the end.
When a patient gets discharged, I do my best to finalize their note right after I print the AVS. Only works if it’s 90% done already.