EmergencyPedia

(1) TESTS

Investigations and Tests:  Be ‘judicious’ with your choice of tests.

Please don’t send alpha-1 antitrypsin, c-peptide, diazepam levels or mast cell tryptase! (or a D-dimer without thought)

By all means take your histories with brevity and send off appropriate tests early.  This will save time and help you achieve the necessary time targets at your hospital.  However, at the same time don’t over order tests that will not change your management.

Be proactive – have a chat with your colleagues about what tests to order if your are not sure…

(2) INTRODUCE YOURSELF

This may seem obvious but sometimes we all resort to automated human behaviour.

N.B. – We are especially vulnerable when we are H.A.L.T. (Hungry, Angry, Late or Tired)

Always establish a rapport and address the patient’s concerns.

Be courteous to colleagues in the same way.

Present your findings accurately

If you get it wrong under stress don’t worry – take a deep breath and start again.

(3) SET UP THE REPUTATION OF OTHERS

Emergency Medicine is a team sport.

Side with your new colleagues (sometimes even when you don’t agree).

Remember to be flexible as there’s usually “more than one way to skin a cat” when it comes to medical care.

When speaking to your patient try and boost the team by putting in a good word about the other health professionals that are also looking after the patient.  “Jane, your nurse, and I will be looking after you this afternoon – she is really great – I believe she is getting your pain medicine now – just while we’re waiting do you have any allergies?“

Use every opportunity to learn the names of your colleagues.  This requires concerted effort as you will frequently be working with a whole set of new doctors and nurses on a daily basis.  Using first names is noticed favourably and persuasive.  Using names is also optimal when communicating in a crisis.

• “keep the nurses and allied health guys ‘on-side’!”

*Thanks to Dr Joe Lex for this tip

(4) PRIVACY

Intimate examinations may be necessary but can be traumatic for the patient.

The ED is not conducive to privacy – there is often very little distance between patients.

Start every consultation by emphasising you really care about the patient’s comfort and privacy.

– “I’m just going to close the curtain now for your privacy – So, how can we help you today?”

Make the point of closing the door (or curtain) and sit down on a chair to talk to the patient

(5) FOLLOW-UP AND LEARN

The best way to learn and improve is follow up your interesting patients.

If you saw 10 patients on a shift always try and check up on how 2 or 3 of your cases progressed during your next shift.

This is also a great way to build rapport with your in-patient colleagues such as surgeons, medics, radiology and critical care.

Likewise, your ears should prick up when patients go to resus – don’t miss out on the potential experience

(6) MAKE YOURSELF ACCESSIBLE

Tell your patient “if there are any problems ask for me in half an hour – I’ll be at the nurses station or over here“.

When you discharge a patient make sure they know it’s okay to come back to the ED if they feel worse.

(7) BE TIME EFFICIENT

There are lots of ways to save time.  You can always write (or type) your notes as you go – this can save a lot of time and allow you to see more cases.  This will keep down the queue and therefore improve patient satisfaction and clinical safety.

(8) ACCEPT YOU MAY BE WRONG

Usually you’ll be right but occasionally we’re all wrong

Don’t shout at radiology if they won’t do your CT – they may have a valid point – and you want them to approve your next CT as well…

Consult widely – time and a fresh perspective often bring the right answer to bear

(9) COMMUNICATION SKILLS

Needless to say clear communication is really important in a busy, stressful environment like the ED.

3 important areas include Documentation of the patient plan, handover and closed loop communication.

(10) PRESCRIBE SAFELY

The most dangerous thing you can do on a shift is pick up a drug chart.

Always write neatly, check all drugs you are unsure about and try to avoid interruptions when prescribing.

Be aware that writing a drug chart up is a high risk pursuit.  Write up appropriate “as required” (PRN) medications for your patients (including analgesia and anti-emetics)

Avoid giving IM/IV/PO drugs by yourself – this can lead to error

Check drug and fluid charts regularly if you are supervising doctor