Category Archives: Clerkship Excellence

EP13. Improve Your Efficiency

24H Le Mans 2013

Wish you were faster in the ED?  Believe it or not, the key to being more efficient is NOT about speed or the ability to multitask.  Instead, becoming an efficient emergency physician takes practice, experience, and the use of some key strategies to increase your productivity.  Be prepared to work hard, work smart, and learn how to task-switch effectively.

In addition, I highly recommend you read this important and informative letter, written by the CDEM Executive Committee, addressing the recent ranking of EM residency programs by U.S. News and World Report and Doximity.

And as an added bonus, check out this just-released video on presenting patients in the ED, put together by some amazingly talented peeps at EMRA and CDEM.  It is hot stuff.

References

  1. Kee R, Knott JC, Dreyfus S, Lederman R, Milton S, Joe K. One hundred tasks an hour: an observational study of emergency department consultant activities. Emerg Med Australas. 2012;24(3):294-302.
  2. Stephens RJ, Fairbanks RJ. Humans and multitask performance: let’s give credit where credit is due. Acad Emerg Med. 2012;19(2):232-4.
  3. Chisholm CD, Dornfeld AM, Nelson DR, Cordell WH. Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices. Ann Emerg Med. 2001;38(2):146-51.
  4. Chisholm CD, Weaver CS, Whenmouth L, Giles B. A task analysis of emergency physician activities in academic and community settings. Ann Emerg Med. 2011;58(2):117-22.
  5. Chisholm CD, Collison EK, Nelson DR, Cordell WH. Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”?. Acad Emerg Med. 2000;7(11):1239-43.
  6. Laxmisan A, Hakimzada F, Sayan OR, Green RA, Zhang J, Patel VL. The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care. Int J Med Inform. 2007;76(11-12):801-11.
  7. Westbrook JI, Woods A, Rob MI, Dunsmuir WT, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med. 2010;170(8):683-90.Photo above Creative Commons License Antoine Valentini via Compfight

EP10. Medical Decision Making and Bias

child Head

How do you get from the classroom to the clinic or hospital ward?  How do you translate knowledge into clinical practice?  Using cognitive strategy techniques can help you understand the medical decision making process.  But beware of bias…

References

1. Sandhu HSS, Carpenter CR. Clinical decision making: opening the black box of cognitive reasoning. Ann Emerg Med. 2006;48:713-719.

2. Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med 2002;9:1184–1204.

3. Kovacs G, Croskerry P. Clinical decision making: an emergency medicine perspective. Acad Emerg Med. 1999;6:947–52.

4. Croskerry, P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Acad. Med. 2003;78:775–780.

Photo Credit: Charly W. Karl via Compfight

EP9. A Look Back at 2014 and Resolutions for the New Year

Happy New Year

2015 is only hours away and yet 2014 was such an exciting year in EM it’s hard to let it go…  Here are some of my favorite articles from 2014!

Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism – PEITHO Investigators

A Randomized Trial of Protocol-Based Care for Early Septic Shock – ProCESS Investigators

Goal-Directed Resuscitation for Patients with Early Septic Shock – ARISE Investigators

Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricullar fibrillation

A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity

Delayed Sequence Intubation: A Prospective Observational Study

Integration of Social Media in Emergency Medicine Residency Curriculum

Photo Credit: Steve Jurvetson via Compfight

EP6. Pain Management

Amoxicillin

Think treating pain can be a pain?  Check out our latest episode for EM Stud’s take on pain management and the dangers of opioids.

References

1. Poon SJ, Greenwood-ericksen MB. The opioid prescription epidemic and the role of emergency medicine. Ann Emerg Med. 2014;64(5):490-5.

2. Cantrill SV, Brown MD, Carlisle RJ, et al. Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012;60(4):499-525.

3. Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol. 2008;16(5):405-16.

4. Washington Emergency Department Opioid Prescribing Guidelines

5. New York City Emergency Department Discharge Opioid Prescribing Guidelines

Creative Commons License Photo Credit: nima; hopographer via Compfight