Tips to be productive in the ED

• Why should you be productive?
• More efficient = more patients seen per shift
• More patients seen per shift = more $ for you -AND- less chance a patient with a serious diagnosis will wait to be seen

• For straightforward diagnoses close out the patient encounter while you are in the room so you don't have to make another visit to the room just to give discharge instructions
  
• "OK Mrs. Smith, your symptoms and physical exam really seem like a UTI. We are going to get a quick urine test to be sure. If that urine test shows a UTI I'll have the nurse give you some antibiotics and your discharge paperwork. Do you have any questions about that plan before I go?"
  

• Communicate with your colleagues
• Let the nurse or tech know what tests or interventions the patient needs and why
• "Can you grab some decadron and three duonebs for this patient"
• "I think its just a mild asthma exacerbation. Lets get some meds going and we can probably discharge this patient home soon"
• Make sure that the nurse or tech knows if certain tests or interventions are holding up the disposition
• "The only thing I need before I can discharge this young woman is the pregnancy test"
• "Would you mind letting me know the result and I'll get her discharge paperwork ready in the meantime"
• If you need to add or change orders let the nurse or tech know asap
• "Hey Mike, I forgot to order a CPK on the man in Room 10. I just put the order into the computer; would you mind calling the lab to make sure it gets run STAT?"
• "Hey Sarah, the woman in Room 15 doesn't seem to be getting much relief from the morphine; I changed her over to hydromorphone. Can you give her a dose?"
  

• Get your diagnostic and therapeutic plan in place as early as possible
• Have the patient start drinking contrast asap if they will need a PO Contrast study
• Get labs, ekg, and urine tests sent of before the patient goes to x-ray, u/s, or CT
  

• Let the patient know what tests or interventions must be completed for you to diagnose and treat them
• "As soon as you can go we need a urine sample - I can't give you a final diagnosis until then. Here is a urine sample cup and the restroom is in that hallway"
• "If you drink down that contrast quickly we can get you over the CT scanner sooner"
  

• Use clinical decision rules (NEXUS, Ottowa knee/ankle/foot, Centor, etc.)
• If you can safely avoid a test or imaging study you can shave hours off a patient's stay