Director's Corner: Lessons in Emergency Medicine Leadership and Management by Silverman Michael

Author:Silverman, Michael [Silverman, Michael]
Language: eng
Format: epub
Publisher: M.L. Plaster Publishing Co., LLC
Published: 2014-09-13T16:00:00+00:00

SECTION IV

Clinical and

Operations

24

In EDs, Efficiency

Is King...No Matter

How You Slice It

Dear Director,

I’ve heard about a technique called “thin slicing” that’s used to increase efficiency. Does it work?

T here are six patients in the “to be seen” rack and you have three hours left of your single-coverage shift. You didn’t realize how quickly the charge nurse was able to clear out the waiting room and now she’s giving you the eye that says you’d better get moving . . . NOW. As an average emergency physician, you know you can do about two patients an hour at this point in your shift so you’re looking at three hours of work in front of you. Your relief comes in three hours but you know you’ll look really bad if they walk in to patients in the rack who have been there for two or more hours. However, you also know that more will come, plus you still need to dispo your existing patients. The challenge is simple: be more efficient and dispo more patients in less time.

Enter the concept of “thin slicing.” First described by Malcolm Gladwell in his book Blink , thin slicing refers to the “gestalt” or “gut” feeling that we have when we know things intuitively. As a colleague recently illuminated, Gladwell’s quasi-scientific reasoning is a good complement to the hypothetico-deductive decision-making that EPs do daily. Think about the doc who comes into their shift and can clear off the ledge of charts that need to be seen in record time. These experienced EPs probably know the ED course and expected outcome and disposition within a minute or two of starting a patient’s H&P. This is an element of thin slicing, but it can be taken to another level.

Here’s the idea. Averaging two patients an hour, you might not see our hypothetical sixth patient for well over two hours. Thin slicing suggests that you see all of those patients over 20 minutes by going into the room, performing only a minimal H&P and then ordering tests based on your experience for the expected outcome.

When I do this, I preface my exam to the patient by explaining that the ED is very busy and I’m trying to expedite their evaluation. To do this, I want to do a brief exam to order the initial tests but I will be back to complete a more thorough exam.

You can think of this as doing a first pass before going back for a second and more complete exam. Typically, a physician can get through each patient initially in just a few minutes, thus allowing lab, radiology, and medication orders to be started.

Now that you understand the concept, here’s my practical advice. For starters, averaging two patients an hour is really just an average. To achieve that during busy periods you’ll need to be able to increase your speed to five or six patients an hour. This is balanced by those hours when no one shows up, when you’re tied up doing critical care and not seeing new patients, and in the last hour of your shift when you’re mostly doing dispos.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.