Am I disillusioned to what ER really is?

[TooMuchResearch]

---

Members don't see this ad.

I know epic collects the information, but we don't review it. I'm sure our medical director reviews it or has access to it, but individual docs don't see it. We've been direct with hospital admin that the LWBS is higher than they want because they don't get our patients upstairs fast enough. They seem to get them upstairs faster when we offer to transfer patients to competitors. LOS improved when we convinced nursing to start pushing patients from the front without triage and started using a fast track. Overall it doesn't run particularly efficiently, but I think it's improving.

Maybe our medical director just goes over metrics with people with problems, unclear to me.

If you used Epic, Cerner, or MedHost the data is there. Epic time stamps “seen” when you sign on to a patient; MedHost has a patient seen icon.

Those times become issues when groups have ****ty metrics like LWOTs, LOS, door to needle, door to balloon, etc. If your group is knocking it out of the ballpark on metrics, it’s unlikely that your CEO or CMO will pull your director or Chair into a meeting with spreadsheets and graphs. They also become issues when a CMG is going after a contact as part of their pitch to the hospital leadership.

 

[ShockIndex]

I know epic collects the information, but we don't review it. I'm sure our medical director reviews it or has access to it, but individual docs don't see it. We've been direct with hospital admin that the LWBS is higher than they want because they don't get our patients upstairs fast enough. They seem to get them upstairs faster when we offer to transfer patients to competitors. LOS improved when we convinced nursing to start pushing patients from the front without triage and started using a fast track. Overall it doesn't run particularly efficiently, but I think it's improving.

Maybe our medical director just goes over metrics with people with problems, unclear to me.

I’ve seen it done a couple of ways. When I worked for EMP a decade ago, the monthly meetings started with metrics which included the group’s collective times including door to doc, LOS, etc. A couple of months, we were presented de-identified individual data because there were wide disparities across the door to doc time largely caused by a handful of docs who were picking up 4 or 5 charts at once and simultaneously clicking “seen” on every chart. This became a problem 1) because it falsifies the medical record when there is a 30 min discrepancy, and 2) someone inevitably picked-up an abdominal pain that was actually a SEMI, saw it last thinking it was BS, and caused a 30 min delay in door to cath lab activation. The quick way to get on the hospital’s ****list is to simultaneously screw the pooch on a core measure and falsify the chart.

In academics, our operations group saw the granular data. I have no idea how outliers were handled.

 

[deleted836128]

Ask most specialists and they will have the same complaints. Eventually everything becomes boring and mindless.

Give me a shift where I can get out and interact with people/staff, grab a cup of coffee during my 4-6 breaks a day.

ER docs need to understand that no matter how busy the ER is, you can always take a 15 min break, go to doc lounge and grab a cup of coffee. Typical day has me going to the cafeteria/doc lounge 4 times in an 8 hr shift.

I like your style. I have a horrible habit of going a whole shift without eating anything and usually one bathroom break.

During rotations I worked with an ER doc that literally took a leisurely SCHEDULED half hour break at the same time every shift (about 2.5 - e hours before the end) to stretch and enjoy a meal. I have no idea how he did this. Without making it a big deal or announcing it to anyone, he somehow wrapped up some things and then walked away, did his thing, and came back very refreshed a half hour later.

 

[GeneralVeers]

I like your style. I have a horrible habit of going a whole shift without eating anything and usually one bathroom break.

During rotations I worked with an ER doc that literally took a leisurely SCHEDULED half hour break at the same time every shift (about 2.5 - e hours before the end) to stretch and enjoy a meal. I have no idea how he did this. Without making it a big deal or announcing it to anyone, he somehow wrapped up some things and then walked away, did his thing, and came back very refreshed a half hour later.

Simple. Just give the unit clerk your cell phone number. I tell them I am taking a break for XX minutes. Anything urgent they can call me.

 

[bravotwozero]

Simple. Just give the unit clerk your cell phone number. I tell them I am taking a break for XX minutes. Anything urgent they can call me.

The ability to do this was the best perk for me coming out of residency - taking a lunch break without having to worry about attendings flipping their ****.

 

[emergentmd]

I have been taking breaks for 20 yrs, never an issue/complaint/bad outcome. Other than specific times when there are critical patients, 99% of the patients are stable and can wait.

My routine walking onto my shift is to clear patients that needs to be seen. Typically 3-5 unassigned patients, put in orders which takes typically 30 minutes at most. Then off to get my pre shift coffee. Any doc who wants to complain can speak to the mirror. If there is no one to be seen, my sitting next to the other doc adds zero to my value.
Every job and specialty takes break all day. You know how I know? I see them in the doc lounge all the time.

Take care of yourself. Make a difficult job sprinkled in with something to look forward to. An ER shift doesn't mean you are stuck in the chair waiting for the next sick patient to be seen.

 

[Groove]

Agree with the importance of short breaks. I never mind if my colleagues leave for a break. I get it. I don't typically leave the ER because I hate the lounge food and I bring my own. I'll typically time my lunch break with the oncoming relief doc. So, if I'm 9-6 and I'm there with the 6-3 doc, I'll break around 2 when our 2-11 doc arrives. The new docs are usually hungry and grabbing everyone off the board and it gives me a nice 15 or 20 mins to eat, stretch, go to the bathroom, etc..