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Tales From The Administrator: ED Flow Part 2 – Throughput

Sam Ashoo, MD
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18:42
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Nurses Edition Commentary

Mel Herbert, MD MBBS FAAEM, Lisa Chavez, RN, and Kathy Garvin, RN
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05:48

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EM:RAP 2015 November Summary 665 KB - PDF

What’s your ED’s plan for times when systems are overwhelmed? Is it a matter of changing staffing or using extra hospital resources when people feel stressed, or are there set criteria that indicate help is needed?

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Matthew J. -

Using throughput metrics in a pinitive fashion worsens morale and assumes that nurses are the single problem, not part of the department function. Those caregivers who are consistently more than 3SD away from the average need to be helped. The alternative approach leads to loss of experienced nurses, worsening the problem.

Patrick M. -

Question about the physician in the waiting room - are you pulling these patients into another room to do everything or just doing it chair to chair in the ED - I have to imagine the former just for pt privacy sake but just wanted to be clear (our shop doesnt have a great space for doing this near the waiting room). We don't too often have a problem with a significant amount of patients in the WR that would necessitate having a specific shift for this - but on some days when we are 15 deep I think it would be a HUGE time saver to go out and plow through those 15 pts to get stuff going than see 1 or 2 pts in the back

Geoffrey W. -

We had a 6 month trial of scribes in our ED when we had a new (and subpar) electronic medical record at our facility. I felt like the scribe didn't necessarily help my charting, and it didn't get me out after a shift any sooner. I still had to go back and correct errors, or make the chart "sound like" myself. However, I know a well trained scribe that works with one provider consistently, can help. The one intervention that most of my colleagues and myself felt was the most beneficial was getting a voice recognition/dictation system (e.g. - Dragon). I feel that was better for me than using a scribe. I still have to go back and correct some dictation errors, but it seems quicker, because I can do that as I am dictating.

Sam Ashoo, MD -

It has been sometime since this recording but if any of you are still interested in patient flow, I've started a new project here: https://admin-em.com/patient-flow/

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Codes and Cath Labs Full episode audio for MD edition 231:38 min - 323 MB - M4AEM:RAP 2015 November Aussie Edition Australian 26:35 min - 36 MB - MP3EM:RAP 2015 November Canadian Edition Canadian 16:25 min - 23 MB - MP3EM:RAP 2015 Español Noviembre 2015 Español 72:56 min - 38 MB - MP3EM:RAP 2015 Novembre Résumé en Francais Français 53:50 min - 32 MB - MP3EM:RAP 2015 Español Noviembre 2015 1 MB - PDFEM:RAP 2015 November Board Review Answers 263 KB - PDFEM:RAP 2015 November Board Review Questions 232 KB - PDFEM:RAP 2015 November MP3 279 MB - ZIPEM:RAP 2015 November Summary 665 KB - PDF

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