ER Scribes: Do you see yourself in EM?

[Hospitalized]

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For all pre-med students, accepted medical students, and current medical students that have dabbled in scribing: Do you see yourself as an emergency room physician? I'll briefly start with some of my thoughts on EM.

Yes because:
Active: Come from a sports background, love teamwork
Procedures: Life saving, gratifying (Intubation, chest tube vs nursemaid's, dislocation reduction)
Social atmosphere
Shift work: Can move into part time easily with seniority, set schedule can happen
No call
Unpredictability

No because:
Burnout
Shift work (yes this goes in both): Getting the shaft as a resident (but who doesn't?)/new attending (lots of nights)
Benign complaints
Outcome of complex cases usually out of your control/scope
Dilaudid 1 mg IV
Ativan 1 mg IV
Charting
No continuity of care

I'm sure there's more, but I'll cut it here. Hope to hear from you all! If any FM or specialty scribes want to chime in on their thoughts about their respective areas that would be nice as well.

In before someone says:
"Just worry about getting into medical school first, decide your specialty later"

 

[Ace Khalifa]

I have shadowed at Barnes-Jewish ER and work in a community hospital ER right now. There's a stark difference in how an academic hospital and a community hospital works, including the ER. I'm not sure which type of ER I would enjoy working in more. I agree with most of your points, tho. I'd say that charting is a negative for every specialty, not just EM. Also, given that I know a bunch of the ER physicians I work with make $300k+ a year working only 45-50 hours a week, EM has very good compensation for the amount and type of work you have to do.

 

[medic86]

I have shadowed at Barnes-Jewish ER and work in a community hospital ER right now. There's a stark difference in how an academic hospital and a community hospital works, including the ER. I'm not sure which type of ER I would enjoy working in more. I agree with most of your points, tho. I'd say that charting is a negative for every specialty, not just EM. Also, given that I know a bunch of the ER physicians I work with make $300k+ a year working only 45-50 hours a week, EM has very good compensation for the amount and type of work you have to do.

The amount of raw hours, sure.

But the amount of work you do? You're very close to 100% utilization working in the ED, as opposed to some other specialties.

I still agree that EM is awesome, though.

 

[darklabel]

I think a lot of scribes want EM because they aren't exposed to many specialties yet (Besides the ones they shadow). There are good things about EM like you listed above that I enjoy, but there are negatives about it. A lot of people see it as a lifestyle specialty, but it isn't necessarily compared to some things out there. I enjoyed the ED and can see it as a good fit, but I definitely want to see what else is out there before being gung ho about EM like half the people in my class seem to be. My main concern is how long I can keep up at 100% utilization.

 

[MedSchool_OR_bust]

I scribed during my gap year and realized this was the specialty for me. I enjoyed the diversity of patients (ages, complaints, acuity), the shift work nature of the job, the ability for instant gratification (quick lab/imaging results, alleviating pain, and the ability to literally save lives), and the fast pace of the ED. Regarding the poor shifts early on (lots of nights/working at boring outlier hospitals), bad scheduling is not mutually exclusive to EM. At least with EM, as you gain seniority, it is not terribly difficult to create schedules that fit your lifestyle. In medical school, I've shadowed in the ED once a month and this has simply furthered my interest. It's awesome getting to actually take the history and perform the physical. The only thing that would make it better is having a scribe 😉

 

[Keladry]

I scribed for a while and loved working in the ER. I'm definitely considering it as a specialty, but I'm also interested in some surgical fields. I'm waiting til post-step 1 and third year to really decide, but EM is definitely on my radar.

 

[prettyNURSEtoMD]

Wanting to give my opinion. Not a scribe, but been an ER nurse my entire time of being a nurse, and my answer is absolutely not. There are perks, such as shift work, no call etc, but I'm burned out by the patient dynamics that we see. Very seldom do we get the life saving gratifying feeling of taking care of that critical patient. 70% of our patients are abusing the system, thanks to EMTALA, look that up if you're unsure what that means, but basically we have to see EVERYBODY that comes through the door. Every patient needs a medical screening exam, unless they choose to be a LWBS. (Left without being seen). So those 3am sore throats, and pregnancy tests really start to wear you down. Those "I slept with my girlfriend and this other chick now i have discharge for 3 weeks" at midnight kill me. Or on "medical Monday" when patients come in because they are hung over and don't want to come to work, so they pollute the waiting rooms...I personally am choosing something else. So for me personally, yes ER is fun when you have a true emergency, but most of the time we don't. Some can take that, but then again EM has a really high burnout rate. This specialty is extremely dependent on the individual, and the location of your facility.

 

[prettyNURSEtoMD]

I have shadowed at Barnes-Jewish ER and work in a community hospital ER right now. There's a stark difference in how an academic hospital and a community hospital works, including the ER. I'm not sure which type of ER I would enjoy working in more. I agree with most of your points, tho. I'd say that charting is a negative for every specialty, not just EM. Also, given that I know a bunch of the ER physicians I work with make $300k+ a year working only 45-50 hours a week, EM has very good compensation for the amount and type of work you have to do.

But remember that 300k is also dependent on the amount of patients you see and the procedures you bill for. So yeah, 45 hours a week, cool but how many did you see in that 12 hours.

 

[medic86]

But remember that 300k is also dependent on the amount of patients you see and the procedures you bill for. So yeah, 45 hours a week, cool but how many did you see in that 12 hours.

Well, that depends on what type of billing the hospital/group/whatever uses. There are models other than incentive-based pay.

 

[medic86]

Wanting to give my opinion. Not a scribe, but been an ER nurse my entire time of being a nurse, and my answer is absolutely not. There are perks, such as shift work, no call etc, but I'm burned out by the patient dynamics that we see. Very seldom do we get the life saving gratifying feeling of taking care of that critical patient. 70% of our patients are abusing the system, thanks to EMTALA, look that up if you're unsure what that means, but basically we have to see EVERYBODY that comes through the door. Every patient needs a medical screening exam, unless they choose to be a LWBS. (Left without being seen). So those 3am sore throats, and pregnancy tests really start to wear you down. Those "I slept with my girlfriend and this other chick now i have discharge for 3 weeks" at midnight kill me. Or on "medical Monday" when patients come in because they are hung over and don't want to come to work, so they pollute the waiting rooms...I personally am choosing something else. So for me personally, yes ER is fun when you have a true emergency, but most of the time we don't. Some can take that, but then again EM has a really high burnout rate. This specialty is extremely dependent on the individual, and the location of your facility.

Or when your tiny ED is deadlocked because almost all of your beds are occupied by patients drinking contrast for an abdominal/pelvis CT. Mehhhh.

 

[cjcarter]

Hell no.

 

[Ace Khalifa]

But remember that 300k is also dependent on the amount of patients you see and the procedures you bill for. So yeah, 45 hours a week, cool but how many did you see in that 12 hours.

Probably a lot. I see no point in being an ER physician if you don't want to see many patients. Also, the place I work at does not do incentive-based pay for this current year; everyone gets the same base salary regardless of how many patients they've seen.

 

[Salt Salt]

Nope. Due to all the listed cons.

 

[Omppu27]

Wasn't an ER scribe (or any type of scribe), but I worked as an EMT for about a year. A majority of our calls weren't emergency, but even just from my experience, I have all but ruled out EM. The unpredictability is exactly why. Goes to show that one's pro is another one's con. To each his own!

 

[TooMuchResearch]

I have shadowed at Barnes-Jewish ER and work in a community hospital ER right now. There's a stark difference in how an academic hospital and a community hospital works, including the ER. I'm not sure which type of ER I would enjoy working in more. I agree with most of your points, tho. I'd say that charting is a negative for every specialty, not just EM. Also, given that I know a bunch of the ER physicians I work with make $300k+ a year working only 45-50 hours a week, EM has very good compensation for the amount and type of work you have to do.

Almost no EM docs work 40+ hours.

 

[TooMuchResearch]

I think a lot of scribes want EM because they aren't exposed to many specialties yet (Besides the ones they shadow). There are good things about EM like you listed above that I enjoy, but there are negatives about it. A lot of people see it as a lifestyle specialty, but it isn't necessarily compared to some things out there. I enjoyed the ED and can see it as a good fit, but I definitely want to see what else is out there before being gung ho about EM like half the people in my class seem to be. My main concern is how long I can keep up at 100% utilization.

There are opportunities in EM outside of larger cities where the doc sees 0.5-1 patients/hr average. No scribes in these places.

 

[Ace Khalifa]

Almost no EM docs work 40+ hours.

The ones I work with do sometimes. It's all based on the monthly schedule.

 

[Hospitalized]

I think a lot of scribes want EM because they aren't exposed to many specialties yet (Besides the ones they shadow). There are good things about EM like you listed above that I enjoy, but there are negatives about it. A lot of people see it as a lifestyle specialty, but it isn't necessarily compared to some things out there. I enjoyed the ED and can see it as a good fit, but I definitely want to see what else is out there before being gung ho about EM like half the people in my class seem to be. My main concern is how long I can keep up at 100% utilization.

Great points. Obviously, you would be cutting yourself short if you didn't give yourself a shot to really like another specialty during the exposure phase of medical school. As scribes, I do feel like we get vague exposure of what other specialties can entail. Very vague, but still. Mostly lifestyle and day-to-day consults.

As long as I've worked, I relate myself much more to the EM physicians than I do to other specialties who come into the ER/hospital. Maybe it's personality, maybe it's just the nature of the diagnosis in the ER that require specialty intervention. Without a doubt, my exposure does not give enough credit to the scope of say, a urologist. Getting a call at 3:00 am because of a difficult foley placement? Meh.

I will say one great thing about ER docs is their broad knowledge and adaptability. Being able to see anyone in any life-threatening scenario and then working through a plan to keep them safe and stable, it's impressive. Of course, it's all part of the health care process. But to me, that initial interaction where you are the one figuring out what's important, what needs to be dealt with now, and how to move forward with treatment is really cool.

 

[Tackycardigan]

I doubt I'd ever want to go into ER medicine because of the patient population. The drug seeking, "My baby has a terrible cough (yet no cough was heard during the three hour wait in the ED)" and "I've had X symptom for two years and now come to the ED at 2am on a Sunday night" people are driving me crazy!

I'm actually leaning more and more toward being a hospitalist. Let the ER doctors filter out the chaff and send the legitimately sick people to me.

 

[YogaBe@r]

I was a scribe in the ER and I definitely never want to go into emergency medicine. I hated the lack of patient continuity. Once they left the ER, you never found out what happened to them. I also dislike some of the patients that you see. Far too many times we had to deal with drug seekers that clogged the waiting rooms or the people that had splinters or tooth aches. I just saw no satisfaction when I worked there. I want to be able to see my patients regularly. Or to see their improvements. And a vast majority of the time was spent waiting for lab work to come in. Sometimes we would have everything ready except one US, and we would have the PT stuck in a usable room for longer than necessary. And not to mention the constant interruptions when talking to pts to answer the doctors that were waiting on the phone.

I know this field is for some people, but it is definitely not for me.

 

[Mayday_]

Wanting to give my opinion. Not a scribe, but been an ER nurse my entire time of being a nurse, and my answer is absolutely not. There are perks, such as shift work, no call etc, but I'm burned out by the patient dynamics that we see. Very seldom do we get the life saving gratifying feeling of taking care of that critical patient. 70% of our patients are abusing the system, thanks to EMTALA, look that up if you're unsure what that means, but basically we have to see EVERYBODY that comes through the door. Every patient needs a medical screening exam, unless they choose to be a LWBS. (Left without being seen). So those 3am sore throats, and pregnancy tests really start to wear you down. Those "I slept with my girlfriend and this other chick now i have discharge for 3 weeks" at midnight kill me. Or on "medical Monday" when patients come in because they are hung over and don't want to come to work, so they pollute the waiting rooms...I personally am choosing something else. So for me personally, yes ER is fun when you have a true emergency, but most of the time we don't. Some can take that, but then again EM has a really high burnout rate. This specialty is extremely dependent on the individual, and the location of your facility.

These are some of the things that are turning me away from EM. I absolutely love the teamwork dynamic at the hospitals I work at. I would love the opportunity to work with PAs/NPs as well as scribes. It's a great opportunity to teach, which I love doing. However, the abuse of the emergency room is getting worse. We've seen a 25% increase in our patient numbers since January and it has been mostly the cough/ear pain/chronic pain types of complaints. I really love EM, but the amount of ED abuse that there is may cause me to burn out quickly.

Is it only me, or does dental pain only seem to be an issue at 3 am? 😴

 

[gyngyn]

Those who do well in EM get their reward from interactions in their immediate sphere of influence (nurses, other ER docs, EMT...) or an intrinsic belief in their own abilities.
There is no other specialty where your patients don't want to be there (or see you), your colleagues in other specialties have a universally low opinion of your management ( in the hospital and out, justifiable or not) and no one asks your opinion on anything. EM is essentially first visits all day. For the right person who needs little external reward, this can be a good job.

Most physicians get their reward (in work) from their patients and their colleagues. Being consulted is an overlooked source of reward that ER docs are unlikely to experience.

 

[prettyNURSEtoMD]

Do you know how many times we have to tell patients we aren't a dentist's office. Unless it's a true true cellulitis and we need OMFS, these patients go home with ibuprofen 800, some abx and they are told to follow up with a dentist. What makes it even worse, the last hospital I worked at had a dental school next to it who advertised for all types of dental issues, starting at 5am. Do they go? Of course not they call an ambulance at 2:45AM....

 

[TooMuchResearch]

I was a scribe in the ER and I definitely never want to go into emergency medicine. I hated the lack of patient continuity. Once they left the ER, you never found out what happened to them. I also dislike some of the patients that you see. Far too many times we had to deal with drug seekers that clogged the waiting rooms or the people that had splinters or tooth aches. I just saw no satisfaction when I worked there. I want to be able to see my patients regularly. Or to see their improvements. And a vast majority of the time was spent waiting for lab work to come in. Sometimes we would have everything ready except one US, and we would have the PT stuck in a usable room for longer than necessary. And not to mention the constant interruptions when talking to pts to answer the doctors that were waiting on the phone.

I know this field is for some people, but it is definitely not for me.

I follow up on my patients regularly. Electronic records make it easy.

 

[almostnever]

I've very much enjoyed my experiences with EM (both at a community hospital and level 1 trauma center). Sure, you get the frequent fliers, psych, routine drunks, people with constant mild foot pain for 1month that decide 3am is the appropriate time to have it evaluated, and people who use the ED as their primary care facility, but there are also patients with acute, serious problems. I actually like the mix of acuity, or lack thereof.

I also like the constant "mode changing" that goes on the in ED. You could be dealing with several non-critical patients that have something critical brought in, or you could have a bunch of serious patients rolled in back to back.

I don't mind the lack of patient continuity thus far, and I do like seeing a bunch of new people everyday (though working with the same staff members is nice). The ability to work shifts, avoid call for the most part, and have time for a family outside of work is also great.

Overall, you're going to be repeating something regardless of specialty, whether that be types of illnesses, type of patients, or types of procedures. I like that EM has the widest variety of repetitions. I'm still very open minded towards other specialties, but so far EM is definitely a front-runner for me.

 

[Ace Khalifa]

you could have a bunch of serious patients rolled in back to back.

Downside to that is you're stuck putting admitting orders in for ALL of them and it makes you fall so far behind in terms of ED workflow. The doc I worked with today was stuck putting in admit orders for 8 patients (that's a lot back to back), with of course the unavoidable distractions like nurses updating on different patients. It took him like 3 hours of straight up charting, including the distractions.

 

[darklabel]

There are opportunities in EM outside of larger cities where the doc sees 0.5-1 patients/hr average. No scribes in these places.

True but you can say that about any specialty. If you work in small towns/fly over states/boonies, it isn't unheard of for an FM doc to make about the same as an EM doc in a desirable location.

 

[Hospitalized]

I will add on one thing to my thread and bump because I know there are more scribes on SDN who have opinions.

Peds EM is pretty interesting. It can be heartbreaking at times, but also very gratifying other times. Kids are so resilient and tend to be much happier than adults when they are feeling better!

 

[Mad Jack]

I have shadowed at Barnes-Jewish ER and work in a community hospital ER right now. There's a stark difference in how an academic hospital and a community hospital works, including the ER. I'm not sure which type of ER I would enjoy working in more. I agree with most of your points, tho. I'd say that charting is a negative for every specialty, not just EM. Also, given that I know a bunch of the ER physicians I work with make $300k+ a year working only 45-50 hours a week, EM has very good compensation for the amount and type of work you have to do.

Working 50 hours in the ED is like working 75 anywhere else. You're constantly busy, stress levels are high, patients are unhappy at best and terrified at worst, and there is zero downtime unless you're in the sticks. Couple that with the rotating schedules (I don't know a single attending that only works days) and you've got one hell of a recipe for stress and burnout. 300k for 50 hours in EM? Yeah, no thanks.

 

[Hospitalized]

patients are unhappy at best and terrified at worst, and there is zero downtime unless you're in the sticks.

Or DOA.

 

[Mad Jack]

Or DOA.

DOA isn't so bad. They're already dead and you almost never get them back if they went down prehospital and EMS couldn't revive them. Nothing tragic about inevitability, what with the nature of life and death and all. Now, fear, fear on the other hand, that's a terrible thing. The dead don't feel it. But your patient who's going all batshiat because their J receptors are firing a mile a minute as his lungs fill with fluid while his heart fails care of fluid overload thanks to him having a bit too much salt on Thanksgiving... Yeah, that's the worst. The dead don't ask you to save them, they don't tell you they don't want to die, begging you to do whatever you can, in between gasping breaths where they beg their families to forgive their wrongs or God to save them. No, the dead are content, unless you bring them back. Not so with the dying. Most people think death is the worst thing you can face, but it's far from it. No, that honor goes to the fear you feel when you're helpless before the specter of death, before you cross over into the unknown.

You won't lose sleep over the DoAs. You will, however, lose sleep over the fearful ones that die after you promise them and their families you'll do everything you can to save them. So that's the worst, at least in my opinion.

 

[Hospitalized]

DOA isn't so bad. They're already dead and you almost never get them back if they went down prehospital and EMS couldn't revive them. Nothing tragic about inevitability, what with the nature of life and death and all. Now, fear, fear on the other hand, that's a terrible thing. The dead don't feel it. But your patient who's going all batshiat because their J receptors are firing a mile a minute as his lungs fill with fluid while his heart fails care of fluid overload thanks to him having a bit too much salt on Thanksgiving... Yeah, that's the worst. The dead don't ask you to save them, they don't tell you they don't want to die, begging you to do whatever you can, in between gasping breaths where they beg their families to forgive their wrongs or God to save them. No, the dead are content, unless you bring them back. Not so with the dying. Most people think death is the worst thing you can face, but it's far from it. No, that honor goes to the fear you feel when you're helpless before the specter of death, before you cross over into the unknown.

You won't lose sleep over the DoAs. You will, however, lose sleep over the fearful ones that die after you promise them and their families you'll do everything you can to save them. So that's the worst, at least in my opinion.

Very well put. I couldn't agree more.

I was just referring to a case in the ED I work at where a 1 year old child was brought in DOA. It's heartbreaking, and it just brought a toll on the department that night. There was nothing anyone could have done to save the child, but the morale is destroyed when you see a child stolen of their chance to live because of someone else's simple mistake.

 

[Mad Jack]

Very well put. I couldn't agree more.

I was just referring to a case in the ED I work at where a 1 year old child was brought in DOA. It's heartbreaking, and it just brought a toll on the department that night. There was nothing anyone could have done to save the child, but the morale is destroyed when you see a child stolen of their chance to live because of someone else's simple mistake.

Yeah, kids are different. They're always rough. Most adults put themselves in the position they're ultimately in, but kids... They usually don't have a choice. It's usually bad genetics, parental mistakes, or some tragic accident that claims them, and that's never easy to deal with. Seems like nonsense, so pointless.

 

[Ace Khalifa]

Working 50 hours in the ED is like working 75 anywhere else. You're constantly busy, stress levels are high, patients are unhappy at best and terrified at worst, and there is zero downtime unless you're in the sticks. Couple that with the rotating schedules (I don't know a single attending that only works days) and you've got one hell of a recipe for stress and burnout. 300k for 50 hours in EM? Yeah, no thanks.

Actually, it's 300k for 35-40 hours. I was wrong about the hours the first time. I know this cuz I asked the docs I worked with. Some days are bad, that's true. Other days, it's relatively benign.

 

[Mad Jack]

Actually, it's 300k for 35-40 hours. I was wrong about the hours the first time. I know this cuz I asked the docs I worked with. Some days are bad, that's true. Other days, it's relatively benign.

36+paperwork is totally doable- 3 12s is pretty normal. Once you start crossing the 40 hour mark though, your sanity will wither fast.

 

[mehc012]

For all pre-med students, accepted medical students, and current medical students that have dabbled in scribing: Do you see yourself as an emergency room physician? I'll briefly start with some of my thoughts on EM.

My reactions to your list (I'm in purple):

Yes because:
Active: Come from a sports background, love teamwork 100% agreed. Love ER shifts, they leave me feeling amped!
Procedures: Life saving, gratifying (Intubation, chest tube vs nursemaid's, dislocation reduction) I also love procedures...but this is almost a con, because I'm not sure ED procedures are enough for me (and also I dislike ortho procedures)
Social atmosphere ED always be bangin'
Shift work: Can move into part time easily with seniority, set schedule can happen No call is nice. Knowing your actual hours ahead of time is wonderful.
No call DING DING DING!
Unpredictability Not really a 'pro' in my book...

No because:
Burnout Eh, I'm still naïve enough to think I'll avoid the pitfalls of those who went before me
Shift work (yes this goes in both): Getting the shaft as a resident (but who doesn't?)/new attending (lots of nights) Love nights, have no set sleep schedule, don't care when I eat/sleep/pee...basically idk about this con. Honestly, it's nice to mix it up a bit.
Benign complaints Kill me now. I would have a hard time not telling these patients what constitutes an Emergency.
Outcome of complex cases usually out of your control/scope We have the winner...this point by itself is why I do not see myself in EM as much as, say, surgery.
Dilaudid 1 mg IV I honestly don't get that bothered over drug seeking. If they want it bad enough to come into the ED and waste hours of their life, no skin off my back. People make choices, some of them are terrible ones for themselves. Refer to pain management and let them do a proper evaluation of whether the pt needs meds or help.
Ativan 1 mg IV It can be really frustrating to treat people for anxiety when they refuse/are incapable of recognizing the possibility that their issue is the anxiety itself. That said, I have a soft spot for mental illness and try to check myself on getting worked up over such things.
Charting I actually don't mind charting all that much. ED charts are easy, and honestly they are a good tool both for myself and the next doc they see. It's not my fav, but I actually enjoyed the charting as a scribe. Then again, I wasn't trying to other, more important tasks at the same time. At any rate, all specialties have charting.
No continuity of care Another big one for me - I don't care about continuity over someone's lifetime, but continuity throughout one presentation (come to hospital, treat problem, continue treating that patient until discharge) is important to me. I want to follow the CASE to its completion, even if I don't care much about following the person.

I'm sure there's more, but I'll cut it here. Hope to hear from you all! If any FM or specialty scribes want to chime in on their thoughts about their respective areas that would be nice as well. I scribed for outpatient ortho for a week or two and left because it was so miserable. Honestly, I think I would prefer to avoid private practice (or at least worker's comp cases). Too many patients, too little time, too little depth in each visit for my tastes.
Shadowing surgery in the hospital, on the other hand...😍

In before someone says:
"Just worry about getting into medical school first, decide your specialty later" Gotta start somewhere. Why do all this shadowing and just IGNORE any specialty differences we stumble across? Will we learn more later? Yup. Does it hurt to gain knowledge (however small) now? I can't see how.

 

[fahimaz7]

ED PGY2 here.

I'd say keep an open mind about the field and see what it's like when you get there. It really doesn't matter if you're a nurse, scribe, tech, registration, person, etc., b/c you won't know what it's like to be a ED resident or attending until you have to do all of the things that we have to do on a daily basis. It's busy, fun, rewarding, and sometimes down right comical. It is extremely different than many of the other fields in medicine, which is why we attract similar personalities to our field that would be equally unhappy doing pediatrics, any medicine sub specialty, or general surgery.

BTW, the average ED attending sees somewhere around 2 patient/hour, which depending on what you see in your critical care bay, can be a very busy shift.

 

[mehc012]

ED PGY2 here.

I'd say keep an open mind about the field and see what it's like when you get there. It really doesn't matter if you're a nurse, scribe, tech, registration, person, etc., b/c you won't know what it's like to be a ED resident or attending until you have to do all of the things that we have to do on a daily basis. It's busy, fun, rewarding, and sometimes down right comical. It is extremely different than many of the other fields in medicine, which is why we attract similar personalities to our field that would be equally unhappy doing pediatrics, any medicine sub specialty, or general surgery.

BTW, the average ED attending sees somewhere around 2 patient/hour, which depending on what you see in your critical care bay, can be a very busy shift.

Is this at a big center? At a little private hospital where the bulk of our ED work was basically primary/urgent care type stuff, we were regularly getting mid 30s on our 12-hr shifts, and 40s was not unheard of. We did tend to see a lot of two/three/fourfers, though. Easier to knock out 4 people when they all come in from the same fender-bender with the same story

 

[MaybeDr]

The thing that I like about EM is that you're the second best at everything but the most useful to your surroundings. The thing I don't like is depending on the area you work in your job can be extremely boring or out of control crazy.

 

[fahimaz7]

Is this at a big center? At a little private hospital where the bulk of our ED work was basically primary/urgent care type stuff, we were regularly getting mid 30s on our 12-hr shifts, and 40s was not unheard of. We did tend to see a lot of two/three/fourfers, though. Easier to knock out 4 people when they all come in from the same fender-bender with the same story

Yes. There is a difference between seeing 20 level 2's and 30 level 3/4 patients. Also depends if you're talking about 8 hour, 10 hour, or 12 hour shifts.

 

[medic86]

Is this at a big center? At a little private hospital where the bulk of our ED work was basically primary/urgent care type stuff, we were regularly getting mid 30s on our 12-hr shifts, and 40s was not unheard of. We did tend to see a lot of two/three/fourfers, though. Easier to knock out 4 people when they all come in from the same fender-bender with the same story

That's it? Jesus.

The tiny 10-bed ED I used to work at had a census of about 40-60 patients from 0700 to 1900. It wasn't unusual for the 24-hour report to have 100+.

 

[HCMVresearcher]

That's it? Jesus.

The tiny 10-bed ED I used to work at had a census of about 40-60 patients from 0700 to 1900. It wasn't unusual for the 24-hour report to have 100+.

Wow! That's a busy little ED for only 10 beds... the ED I work in right now isn't much larger (22 beds if you include the 6 express care rooms) and we see an average of 70 patients in a 24 hour period. I've only seen two 100+ days since I started in December... and it was just crazy.

 

[HCMVresearcher]

.

 

[mehc012]

That's it? Jesus.

The tiny 10-bed ED I used to work at had a census of about 40-60 patients from 0700 to 1900. It wasn't unusual for the 24-hour report to have 100+.

Did your ED only have one doc/PA on staff? Because I was talking single-provider number, not census. The census was much higher, of course.

 

[mehc012]

Yes. There is a difference between seeing 20 level 2's and 30 level 3/4 patients. Also depends if you're talking about 8 hour, 10 hour, or 12 hour shifts.

I know there's a difference, that's why I was asking! We had a high and a low acuity side (of course this distinction was fuzzy and rooming was always largely dependent on bed availability)...the numbers were usually about the same on each side since 2 docs staff the low side and 1 staffs the high during peak (and the high side doc comes over to help out when they can) And I specified 12hr shifts for ours.

The PAs take most of the straight-up urgent care stuff, but on a crazy day there's plenty left for the docs. We were also the stroke/heart attack center for the area, so we got a ton of those. What we didn't see is a high volume of severe traumas, which is what I was wondering about.

 

[Hospitalized]

That's it? Jesus.

The tiny 10-bed ED I used to work at had a census of about 40-60 patients from 0700 to 1900. It wasn't unusual for the 24-hour report to have 100+.

As long as the staffing is there, 10 beds can be better than 20 if the patients don't flood in all at once. A lot of what holds up an ED is logistics. And drinking contrast. 😉

 

[Hospitalized]

Wow! That's a busy little ED for only 10 beds... the ED I work in right now isn't much larger (22 beds if you include the 6 express care rooms) and we see an average of 70 patients in a 24 hour period. I've only seen two 100+ days since I started in December... and it was just crazy.

Try ~250 in 24 hours during peak flu. 36 bed ED... I think around 20-30 left without being seen because of wait times. We had a streak of 5 days or something over 200. Madness... and quite frankly unsafe.

 

[HCMVresearcher]

Try ~250 in 24 hours during peak flu. 36 bed ED... I think around 20-30 left without being seen because of wait times. We had a streak of 5 days or something over 200. Madness... and quite frankly unsafe.

Yikes!!! 250?! I can't even imagine that!

 

[fahimaz7]

We see 250 at our place/day. But we have triple attending coverage and anywhere between 2 and 8 residents going at one time. We're moderately busy by residency standards, but about 40% of ours are level 2s which take quite a bit of time. 25-30% admission rates.

 

[frosted_flake]

I am an EMT, but I could definitely see myself in EM.