Interruptions

[GonnaBeADoc2222]

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How do you minimize these?

Why do people not have the self awareness not to interrupt you when you appear to be mentally engaged with another task?

It's infuriating. I feel like I probably miss stiff because of it.

 

[Apollyon]

"Punch clock villains". The person interrupting you doesn't care, and is not invested in their job. Add ego, and there you go. When someone thinks that their time is more important than yours, they interrupt you with impunity.

 

[southerndoc]

It's one thing to get interrupted while doing a task (i.e., placing orders in the computer), but it infuriates me when a tech asks me to sign a triage EKG while I'm in the office eating.

I've been known to take the battery out of my phone when it starts ringing too much. Nurses call for the silliest crap (can I have more Zofran for patient in 31? Well, did you see there's a PRN order?). If they truly needed me, they would page me overhead.

 

[Tenk]

We need those little cards from fogo de chao on our bodies and when they are red they know not to bother us, when we flip green we are ready to be bombarded with questions and delicious meats.

 

[GeneralVeers]

We need those little cards from fogo de chao on our bodies and when they are red they know not to bother us, when we flip green we are ready to be bombarded with questions and delicious meats.

Red....always Red

 

[TooMuchResearch]

Red....always Red

But then how do I get the meat?

 

[namethatsmell]

The surest way I've found to not be interrupted is to grab one of the computers on wheels and hide with it in a back hallway or hidden nook in the department. It's glorious.

 

[GeneralVeers]

The surest way I've found to not be interrupted is to grab one of the computers on wheels and hide with it in a back hallway or hidden nook in the department. It's glorious.

But what about the EKGS???? They've GOT TO BE SIGNED!!!!!! 😵😵😵😵😵😵😵

 

[southerndoc]

One of our techs was walking down the hallway and saw me round the corner walking toward our office. She actually turned around to go get another doc to sign the EKG. Mission accomplished!

 

[scummie]

I personally loathe interruptions during sign out. I’ll tell them that unless it’s life or death, come back on a few minutes. I think I read somewhere that the average interruptions is 8 per hour. That seems way too low.

 

[GonnaBeADoc2222]

I personally loathe interruptions during sign out. I’ll tell them that unless it’s life or death, come back on a few minutes. I think I read somewhere that the average interruptions is 8 per hour. That seems way too low.

Wayyyy low

 

[TooMuchResearch]

I personally loathe interruptions during sign out. I’ll tell them that unless it’s life or death, come back on a few minutes. I think I read somewhere that the average interruptions is 8 per hour. That seems way too low.

I recall seeing 18 per hour.

 

[RustedFox]

I have evolved a great way to extinguish this. It goes like this:

[RF is tapping away at keyboard, charting]
RN: "Hey, the patient in room 4 want to kn-"
RF: (Interrupting) "Standby."
RN: [Waits, while I finish importing labs, reviewing CT, or doing what it was that I was doing.]
RF: "Go."

They want to interrupt? I make them wait.
Now, I'm not interrupted. They approach, and wait to be acknowledged.

 

[deleted836128]

Yikes. I hate to be interrupted - I feel like I am interrupted more than eight times an hour - but in the ER setting I don’t think it’s necessarily rude? I find it annoying but necessary. I expect it. Someone always comes up to me to ask me to look an EKG, sign something, tell me I have a phone call, tell me someone needs more pain meds. I actually find it more annoying when someone stands there next to me and doesn’t say anything and waits for me to notice them. That seems passive and people who do that annoy the heck out of me. These posts make me feel a little bad because I technically interrupt RNs and other staff all the time. If I have a question I will go right up and ask it (unless they’re on the phone or in the middle of a dictation). I am not going to sit there and stand by a nurse while she talks to a coworker about her weekend so I can tell her to give someone nitro (trust me, I have tried standing there and it doesn’t work - they literally keep chatting). So I say, “Hey, Sally?” And wait for a response. If I am interrupting I say “sorry to interrupt.” Interruptions are annoyIng But didn’t we sign up for that when we work in the ER and are approached by patients with questions, family members asking for blankets, specialists, hospitalist, nurses, radiology techs, etc? If I see this wrong definitely enlighten me because I definitely do not want to be rude or get on someone’s bad side.

 

[GonnaBeADoc2222]

Yikes. I hate to be interrupted - I feel like I am interrupted more than eight times an hour - but in the ER setting I don’t think it’s necessarily rude? I find it annoying but necessary. I expect it. Someone always comes up to me to ask me to look an EKG, sign something, tell me I have a phone call, tell me someone needs more pain meds. I actually find it more annoying when someone stands there next to me and doesn’t say anything and waits for me to notice them. That seems passive and people who do that annoy the heck out of me. These posts make me feel a little bad because I technically interrupt RNs and other staff all the time. If I have a question I will go right up and ask it (unless they’re on the phone or in the middle of a dictation). I am not going to sit there and stand by a nurse while she talks to a coworker about her weekend so I can tell her to give someone nitro (trust me, I have tried standing there and it doesn’t work - they literally keep chatting). So I say, “Hey, Sally?” And wait for a response. If I am interrupting I say “sorry to interrupt.” Interruptions are annoyIng But didn’t we sign up for that when we work in the ER and are approached by patients with questions, family members asking for blankets, specialists, hospitalist, nurses, radiology techs, etc? If I see this wrong definitely enlighten me because I definitely do not want to be rude or get on someone’s bad side.

When you are interrupting to ask the RN to please obtain the urine you ordered 2 hrs ago while they are talking about weekend plans, you are doing your job.

I have been interrupted during physician signout, while doing a central line, while inducing RSI. I've been interrupted in the middle of an interruption; basically an interruption inception.

The EKG, the pain med order, the restraint order, the this/that person wants an update can wait. Do not interrupt me unless a patient is actively decompensating.

How many times you see a surgeon be interrupted while they are doing something critical to their job?

 

[Matthew9Thirtyfive]

How many times you see a surgeon be interrupted while they are doing something critical to their job?

A lot. Nurses barge into the room or call into the room and interrupt during critical parts of cases all the time, at least where I’ve worked. Not to mention the pager.

 

[Birdstrike]

In the ED, almost everything can wait. But nothing can wait.

 

[Shufflin]

When I'm flying a plane, the flight attendant doesn't barge into the cabin to give me updates. Likewise, I imagine in the ED there should be some boundary protocols.

 

[deleted836128]

When you are interrupting to ask the RN to please obtain the urine you ordered 2 hrs ago while they are talking about weekend plans, you are doing your job.

I have been interrupted during physician signout, while doing a central line, while inducing RSI. I've been interrupted in the middle of an interruption; basically an interruption inception.

The EKG, the pain med order, the restraint order, the this/that person wants an update can wait. Do not interrupt me unless a patient is actively decompensating.

How many times you see a surgeon be interrupted while they are doing something critical to their job?

But when in the ER are you NOT doing some important task? I feel like every second of every minute I am doing some task - putting in an order, running to see a patient, suturing, talking to a specialist, putting in labs, dictating. There is not one minute of my day when I am not doing some task. I have to strategize when I can go to the bathroom for God’s sake (once or max twice per twelve hour shift) because there’s so much crap I have to be doing all the time. And I know I am not alone in this. So is there truly a good time to be approached by coworkers in this field? Everything in the ER is a race to beat the clock and keep things moving. With a few exceptions (ie I am on the phone or my patient is crashing) I don’t want staff to feel like they have to “wait for a polite time” to ask what they need. A nurse is literally, secretly on my bad side for standing next to me in silence while I am dictating waiting for me to acknowledge her. And what a waste of HER time to be sitting there waiting to be noticed. We don’t have time for that sh$t. It’s annoying to be interrupted but the more time spent waiting for me, the longer it takes everyone else to do their job and that slows the whole department down. I hate interruptions as well but I feel they’re just part of the ER. Plus, part of our job is being able to multitask. We have to juggle many things at once.

 

[EsTxDr]

But when in the ER are you NOT doing some important task? I feel like every second of every minute I am doing some task - putting in an order, running to see a patient, suturing, talking to a specialist, putting in labs, dictating. There is not one minute of my day when I am not doing some task. I have to strategize when I can go to the bathroom for God’s sake (once or max twice per twelve hour shift) because there’s so much crap I have to be doing all the time. And I know I am not alone in this. So is there truly a good time to be approached by coworkers in this field? Everything in the ER is a race to beat the clock and keep things moving. With a few exceptions (ie I am on the phone or my patient is crashing) I don’t want staff to feel like they have to “wait for a polite time” to ask what they need. A nurse is literally, secretly on my bad side for standing next to me in silence while I am dictating waiting for me to acknowledge her. And what a waste of HER time to be sitting there waiting to be noticed. We don’t have time for that sh$t. It’s annoying to be interrupted but the more time spent waiting for me, the longer it takes everyone else to do their job and that slows the whole department down. I hate interruptions as well but I feel they’re just part of the ER. Plus, part of our job is being able to multitask. We have to juggle many things at once.

Agree to a point, interruptions are absolutely part of the job however its pretty clearly documented that these lead to mistakes and fractured care. The ability to manage interruptions (including true "break in task" interruptions) is really part of managing your ED. The system itself has built in interruptions, add in the necessary interruptions, and avoiding unnecessary or mis-timed interruptions becomes absolutely vital. I think developing the ability to sign an EKG and continue on your given task (etc) is important, but being able to tell a nurse to "stand by" to finish that important order entry, or finish the thought process you are on, especially when asking for a turkey sammich ... is important as well.

Emergency department workplace interruptions: are emergency physicians "interrupt-driven" and "multitasking"? - PubMed

Emergency physicians are "interruptdriven." Emergency physicians are frequently interrupted and many interruptions result in breaks-in-task.

www.ncbi.nlm.nih.gov

Study tracks effects of interruptions on doctors - CNN.com

Interruptions in the emergency room may exact an unhealthy toll on patient care, a group of Australian researchers reported Thursday.

www.cnn.com

Risk of Medical Errors by ED Doctors Linked to Interruptions

Interruptions that cause emergency department doctors to change tasks and leave tasks unfinished, detract from direct patient care and contribute to the potential for medical error, researchers say.

www.healthleadersmedia.com

 

[GonnaBeADoc2222]

But when in the ER are you NOT doing some important task? I feel like every second of every minute I am doing some task - putting in an order, running to see a patient, suturing, talking to a specialist, putting in labs, dictating. There is not one minute of my day when I am not doing some task. I have to strategize when I can go to the bathroom for God’s sake (once or max twice per twelve hour shift) because there’s so much crap I have to be doing all the time. And I know I am not alone in this. So is there truly a good time to be approached by coworkers in this field? Everything in the ER is a race to beat the clock and keep things moving. With a few exceptions (ie I am on the phone or my patient is crashing) I don’t want staff to feel like they have to “wait for a polite time” to ask what they need. A nurse is literally, secretly on my bad side for standing next to me in silence while I am dictating waiting for me to acknowledge her. And what a waste of HER time to be sitting there waiting to be noticed. We don’t have time for that sh$t. It’s annoying to be interrupted but the more time spent waiting for me, the longer it takes everyone else to do their job and that slows the whole department down. I hate interruptions as well but I feel they’re just part of the ER. Plus, part of our job is being able to multitask. We have to juggle many things at once.

Is your argument really "everything is important, so nothing is important" ?

 

[Dr Mantis Toboggan]

Good nurses will shield us from nonsense questions/requests:

“Dr, your suicidal hold in bed 3 is requesting methadone. What should I tell them?!?”

“Uh, we never give methadone. Ever. So no.”

“Your NSTEMI patient is requesting that they be allowed to smoke.”

Etc.

Good ED nurses will walk the line between bombarding us with useless info like that while not ignoring a crashing patient while texting on their phones. Sadly they are becoming more and more rare.

But when in the ER are you NOT doing some important task? I feel like every second of every minute I am doing some task - putting in an order, running to see a patient, suturing, talking to a specialist, putting in labs, dictating. There is not one minute of my day when I am not doing some task. I have to strategize when I can go to the bathroom for God’s sake (once or max twice per twelve hour shift) because there’s so much crap I have to be doing all the time. And I know I am not alone in this. So is there truly a good time to be approached by coworkers in this field? Everything in the ER is a race to beat the clock and keep things moving. With a few exceptions (ie I am on the phone or my patient is crashing) I don’t want staff to feel like they have to “wait for a polite time” to ask what they need. A nurse is literally, secretly on my bad side for standing next to me in silence while I am dictating waiting for me to acknowledge her. And what a waste of HER time to be sitting there waiting to be noticed. We don’t have time for that sh$t. It’s annoying to be interrupted but the more time spent waiting for me, the longer it takes everyone else to do their job and that slows the whole department down. I hate interruptions as well but I feel they’re just part of the ER. Plus, part of our job is being able to multitask. We have to juggle many things at once.

 

[Groove]

My colleagues will go hide at any work station that is far away from triage so that the EKG tech can't find them. Therefore, I get to sign all the EKGs that get trust in my face while I'm dictating, on the phone or trying to put in orders. Some days I feel like grabbing their head with both hands and ripping it clean off their shoulders and shoving EKG paper down their throat all while cackling "CAN YOU SIGN THIS FOR ME?! AHAHAHA, SIGN THIS FOR ME?!?!?". Then I just shudder....take a deep breath, sign it and hand it back to them.

 

[RocuROMANium]

Ok, so I’m that annoying EKG tech. Now I’m not going to go on a whiny tangent about what it’s like to be us and you guys are mean blah blah blah because I think you guys do know we have to get those triage EKGs signed within 5 minutes of doing them and you all are under a lot more pressure than us.

The biggest issue I have with this whole stupid EKG signing issue is that I have yet to hear any intelligent discussions on how to fix it. So please enlighten me if you can but I’ll try first. I work in a large and busy ED so the following ideas are from that perspective:

In hourly blocks there are assigned physicians to sign EKGs and when those blocks expire their off the hook

Tube triage EKGs to a central location and whoever is there can sign it and you guys can decide whose turn it is

Have a red and green light system where you guys tell us when you’re available (I definitely don’t trust this one ha)

Or have an online EKG system where triage EKGs digitally transfer to EPIC to all ED physicians and whoever gets to it first can look at it and sign it digitally

I definitely see issues with all of these ideas like the first one overwhelming the assigned physicians with hordes of EKGs at busy hours, the issue with the second one is that these EKGs have to be signed within a 5 minute time frame and you all might be in patient rooms, the third idea would be troublesome because everyone would have their red lights on (as someone mentioned above), and the last idea I believe is the best one but there might still be issues with getting them signed in within time.

These might not be the best ideas but hopefully one of you guys can figure something out. If you can’t, then I will take your whining as a way to vent.

 

[Groove]

Ok, so I’m that annoying EKG tech. Now I’m not going to go on a whiny tangent about what it’s like to be us and you guys are mean blah blah blah because I think you guys do know we have to get those triage EKGs signed within 5 minutes of doing them and you all are under a lot more pressure than us.

The biggest issue I have with this whole stupid EKG signing issue is that I have yet to hear any intelligent discussions on how to fix it. So please enlighten me if you can but I’ll try first. I work in a large and busy ED so the following ideas are from that perspective:

In hourly blocks there are assigned physicians to sign EKGs and when those blocks expire their off the hook

Tube triage EKGs to a central location and whoever is there can sign it and you guys can decide whose turn it is

Have a red and green light system where you guys tell us when you’re available (I definitely don’t trust this one ha)

Or have an online EKG system where triage EKGs digitally transfer to EPIC to all ED physicians and whoever gets to it first can look at it and sign it digitally

I definitely see issues with all of these ideas like the first one overwhelming the assigned physicians with hordes of EKGs at busy hours, the issue with the second one is that these EKGs have to be signed within a 5 minute time frame and you all might be in patient rooms, the third idea would be troublesome because everyone would have their red lights on (as someone mentioned above), and the last idea I believe is the best one but there might still be issues with getting them signed in within time.

These might not be the best ideas but hopefully one of you guys can figure something out. If you can’t, then I will take your whining as a way to vent.

There's no perfect system and we get that you need to find a doc to sign these things. What would help tremendously, is if you guys made an effort to disperse the EKGs in a fair and equal manner to the docs in the ED instead of making a bee line to the closest physician workstation. I keep asking the techs if they are having the other docs sign the EKGs and everyone always tells me they are, yet when I experiment by sitting on the other side of the department, I never get an EKG over there. I've gone an entire shift sitting over there with no EKGs to sign.

The other thing is to just try and be courteous. Many times the tech will show up and thrust it on my keyboard, or in my face, or interrupt me to ask for the EKG and it's just rude. I even had one interrupt me while I was getting a history from a patient. Stand there quietly and wait for an opportune moment to ask for a signature unless it reads "STEMI". If you're standing there beside us, we aren't blind. I can easily see that you need an EKG signed and chances are I'm doing something important and will turn to you as soon as able. Exercise some courtesy.

Look at the tracking board and see which physician is assigned to the pt. If it's the doc's pt who is hiding on the other side of the ER, do us both a favor and go find him/her.

 

[TooMuchResearch]

Ok, so I’m that annoying EKG tech. Now I’m not going to go on a whiny tangent about what it’s like to be us and you guys are mean blah blah blah because I think you guys do know we have to get those triage EKGs signed within 5 minutes of doing them and you all are under a lot more pressure than us.

The biggest issue I have with this whole stupid EKG signing issue is that I have yet to hear any intelligent discussions on how to fix it. So please enlighten me if you can but I’ll try first. I work in a large and busy ED so the following ideas are from that perspective:

In hourly blocks there are assigned physicians to sign EKGs and when those blocks expire their off the hook

Tube triage EKGs to a central location and whoever is there can sign it and you guys can decide whose turn it is

Have a red and green light system where you guys tell us when you’re available (I definitely don’t trust this one ha)

Or have an online EKG system where triage EKGs digitally transfer to EPIC to all ED physicians and whoever gets to it first can look at it and sign it digitally

I definitely see issues with all of these ideas like the first one overwhelming the assigned physicians with hordes of EKGs at busy hours, the issue with the second one is that these EKGs have to be signed within a 5 minute time frame and you all might be in patient rooms, the third idea would be troublesome because everyone would have their red lights on (as someone mentioned above), and the last idea I believe is the best one but there might still be issues with getting them signed in within time.

These might not be the best ideas but hopefully one of you guys can figure something out. If you can’t, then I will take your whining as a way to vent.

There was at least on study showing it is probably safe to just have normal computer read ECGs not have physician review until they get to a room. It was only about 900 patients.

 

[deleted109597]

Trust me on this. Signing them is much, much better than coming to your desk from a patient's room and seeing one (or many) on the keyboard.
I've found ones in charts that say Acute MI that are an hour old and aren't signed.
I found on on the keyboard that literally had 1 QRS complex on the whole thing. I had to hunt down the patient to find them quite literally dead.
The bigger problem is why do we keep hiring *****s?

 

[turkeyjerky]

Ok, so I’m that annoying EKG tech. Now I’m not going to go on a whiny tangent about what it’s like to be us and you guys are mean blah blah blah because I think you guys do know we have to get those triage EKGs signed within 5 minutes of doing them and you all are under a lot more pressure than us.

The biggest issue I have with this whole stupid EKG signing issue is that I have yet to hear any intelligent discussions on how to fix it. So please enlighten me if you can but I’ll try first. I work in a large and busy ED so the following ideas are from that perspective:

In hourly blocks there are assigned physicians to sign EKGs and when those blocks expire their off the hook

Tube triage EKGs to a central location and whoever is there can sign it and you guys can decide whose turn it is

Have a red and green light system where you guys tell us when you’re available (I definitely don’t trust this one ha)

Or have an online EKG system where triage EKGs digitally transfer to EPIC to all ED physicians and whoever gets to it first can look at it and sign it digitally

I definitely see issues with all of these ideas like the first one overwhelming the assigned physicians with hordes of EKGs at busy hours, the issue with the second one is that these EKGs have to be signed within a 5 minute time frame and you all might be in patient rooms, the third idea would be troublesome because everyone would have their red lights on (as someone mentioned above), and the last idea I believe is the best one but there might still be issues with getting them signed in within time.

These might not be the best ideas but hopefully one of you guys can figure something out. If you can’t, then I will take your whining as a way to vent.

The truth is that the EKG thing is just a ****ty situation. There are lots of ****ty situations in the ED w/o a quick or satisfying fix--sometimes we just need to bitch about it.

A lot of interruptions are avoidable. I don't need to know immediately if the trop is .05 or the lactate is 2.1. (I'll see this myself w/in a few min anyway). Our radiologists call us up a lot to tell us routine findings--like a nodule or a pneumonia on a cxr, or an equivocal finding just to 'fyi' us. These calls get handled by the unit clerk with the same urgency as a call notifying us of a head bleed or massive PE.

I don't need to be asked by a nurse whether or not a patient can go to the bathroom, and I don't need to be told every time the drug seeker is requesting more pain meds. Hell, sometimes a nurse will come over and ask me whether it's okay to give the 2nd prn dose I've already ordered.

I don't get it. Someone just needs to tell everyone that they're actually causing harm to patient care with all these inane interruptions. Instead, I'm sure the nurses are hearing the opposite from their management.

 

[TooMuchResearch]

The truth is that the EKG thing is just a ****ty situation. There are lots of ****ty situations in the ED w/o a quick or satisfying fix--sometimes we just need to bitch about it.

A lot of interruptions are avoidable. I don't need to know immediately if the trop is .05 or the lactate is 2.1. (I'll see this myself w/in a few min anyway). Our radiologists call us up a lot to tell us routine findings--like a nodule or a pneumonia on a cxr, or an equivocal finding just to 'fyi' us. These calls get handled by the unit clerk with the same urgency as a call notifying us of a head bleed or massive PE.

I don't need to be asked by a nurse whether or not a patient can go to the bathroom, and I don't need to be told every time the drug seeker is requesting more pain meds. Hell, sometimes a nurse will come over and ask me whether it's okay to give the 2nd prn dose I've already ordered.

I don't get it. Someone just needs to tell everyone that they're actually causing harm to patient care with all these inane interruptions. Instead, I'm sure the nurses are hearing the opposite from their management.

The lab now calls us directly with any "critical results." I guess the nurses decided it was better for their Facebook checking, I mean patient care, to have us get those calls.

 

[southerndoc]

My ER doesn't allow the nurses to use cell phones while on duty. The only reason the physicians can use them is because of PerfectServe (our communication app).

 

[deleted109597]

The lab now calls us directly with any "critical results." I guess the nurses decided it was better for their Facebook checking, I mean patient care, to have us get those calls.

I got written for answering the phone when the HUC would say "Nurse pickup line one for critical results".
Apparently I wasn't putting a note in the system with the name of the lab person. Even though they put one in saying they spoke with me. And I'm the one who ultimately acts on them.
At least I got the medical director to squash it, but only after promising that I wasn't trying to get all of the doctors to do this.

 

[thegenius]

How do you minimize these?

Why do people not have the self awareness not to interrupt you when you appear to be mentally engaged with another task?

It's infuriating. I feel like I probably miss stiff because of it.

The interrupting conversation is always more important than the primary conversation, that's why!

There is a guy I work with who will put up a sign on his desk saying "Do not bother me I'm doing notes" and everyone (except for his scribe) know not to talk to him during this time.

 

[thegenius]

Ok, so I’m that annoying EKG tech. Now I’m not going to go on a whiny tangent about what it’s like to be us and you guys are mean blah blah blah because I think you guys do know we have to get those triage EKGs signed within 5 minutes of doing them and you all are under a lot more pressure than us.

The biggest issue I have with this whole stupid EKG signing issue is that I have yet to hear any intelligent discussions on how to fix it. So please enlighten me if you can but I’ll try first. I work in a large and busy ED so the following ideas are from that perspective:

We are not mad at you guys, believe me. It's not your fault.

We are just venting.

EKGs (for me) are the least problematic of all the interruptions.

 

[thegenius]

There was at least on study showing it is probably safe to just have normal computer read ECGs not have physician review until they get to a room. It was only about 900 patients.

yea...until you read Stephen Smith's blog which is all about subtle occlusive MI findings on EKGs. Some of which are interpreted as "Normal Sinus Rhythm."

 

[RocuROMANium]

There's no perfect system and we get that you need to find a doc to sign these things. What would help tremendously, is if you guys made an effort to disperse the EKGs in a fair and equal manner to the docs in the ED instead of making a bee line to the closest physician workstation. I keep asking the techs if they are having the other docs sign the EKGs and everyone always tells me they are, yet when I experiment by sitting on the other side of the department, I never get an EKG over there. I've gone an entire shift sitting over there with no EKGs to sign.

The other thing is to just try and be courteous. Many times the tech will show up and thrust it on my keyboard, or in my face, or interrupt me to ask for the EKG and it's just rude. I even had one interrupt me while I was getting a history from a patient. Stand there quietly and wait for an opportune moment to ask for a signature unless it reads "STEMI". If you're standing there beside us, we aren't blind. I can easily see that you need an EKG signed and chances are I'm doing something important and will turn to you as soon as able. Exercise some courtesy.

Look at the tracking board and see which physician is assigned to the pt. If it's the doc's pt who is hiding on the other side of the ER, do us both a favor and go find him/her.

I mistakenly assumed those qualities in my post because I forgot that some techs don’t have common sense. I rotate, wait patiently, definitely don’t interrupt pt care (you kidding me?), and always take EKGs to the ordering physician if applicable. I haven’t noticed much of a difference in complaining but I’m just one tech of many. Sometimes I just tell you guys that I’m trying to rotate and that seems to make the best impact funny enough.

 

[RustedFox]

Here's the thing about EKGs:

When a tech hands me an EKG, I don't even bother to look at the clock. I simply sign "NO STEMI: R.Fox" and then sign the EXACT SAME time that is on the EKG itself. Nobody is ever going to be able to tell that it wasn't seen/read in five minutes time unless there's a digital timestamp on it.

 

[thegenius]

Here's the thing about EKGs:

When a tech hands me an EKG, I don't even bother to look at the clock. I simply sign "NO STEMI: R.Fox" and then sign the EXACT SAME time that is on the EKG itself. Nobody is ever going to be able to tell that it wasn't seen/read in five minutes time unless there's a digital timestamp on it.

Me too.

 

[southerndoc]

There was at least on study showing it is probably safe to just have normal computer read ECGs not have physician review until they get to a room. It was only about 900 patients.

Do you have a citation?

 

[RustedFox]

Me too.

Thus, we have a metric that is unenforceable and ultimately doesn't matter.
Thanks, administrators! How much money did you steal in your annual bonus for meeting that metric?

Mrs. Fox and I went out to lunch the other day.
Great restaurant. I had a chicken chimichurri flatbread with goat cheese, roasted red peppers, etc. It was soooo good.
We always sit at the bartop. We like being at a "corner", because she is left-handed and that way there's no way our elbows can bump.

We're enjoying our meal, and we can't help but overhear a conversation between two old men a few barstools away.
Blah, blah, blah... rate of return, blah BLAH blah... mergers and acquisitions... blahhh... market forces.

I look over at them. Mrs. Fox can already see the venom in my gaze. I snarl internally. I want to sink my fangs into their neck and clench until they stop bleating and kicking like the mindless sheep that they are.

Both of them are wearing an awful button-down oxford with their initials embroidered on their sleeves and collars that don't match the color of the shirt (why anyone would do that is beyond me..... white collar, blue shirt? seems an open mockery to me). Their expensive watches are clearly poorly cared for. The lines on their faces are highlighted subtly with nicotine from their expensive cigars. The piece de resistance (sp?) are those God-Awful "horse stirrup" charms on their loafers. Everything about them says: "Look at this! It's expensive! Are you impressed?"

These are the marks of a corporate @sshole.

They like expensive things, but they don't have the intellectual capacity to understand what's behind the things that they treasure. They have their status symbols, but they don't understand why. They're the type that couldn't pass high-school chemistry, but would love to put on the air that they are masters of everything that they do... which is actually fitting, as all that they really do is sit in meetings and shuffle paperwork. They can't tell you why "Fahrenheit 451" is an appropriate title, but they have lots of big books on their bookshelves in their oak-clad offices that they have... never opened.

You can make a counter-argument about ER doc tropes and they are generally true.

We have carabiners on our keychains.
We buy "GoPro" accessories.
We flock to mountain sports and music festivals.

But the difference is: we generally understand and appreciate what we have, and what we like. We like the things that we like, because we LIKE them, not because "this is expensive: look at it!" My most treasured items aren't expensive items, and I care for them.

When someone on an airplane gets dyspneic and starts to struggle, nobody says: "Is there a regional vice-president on board?"

...

For the record, Mrs. Fox was successful in stopping me from saying something unkind. I said to her "I would not be able to live with myself if I were like that."

She replied with: "I know. I wouldn't have married you if you were only interested in how expensive your next watch was."

 

[thegenius]

Do you have a citation?

Here it is

 

[TooMuchResearch]

yea...until you read Stephen Smith's blog which is all about subtle occlusive MI findings on EKGs. Some of which are interpreted as "Normal Sinus Rhythm."

How many of those people died in the waiting room?

 

[scummie]

Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices.
Chisholm CD, et al. Ann Emerg Med. 2001.

“Emergency physicians were interrupted an average of 9.7 times per hour compared with 3.9 times per hour for PCPs, for an average difference of 5.8 times per hour (95% confidence interval [CI] 4.2 to 7.4).”

Emergency department workplace interruptions: are emergency physicians "interrupt-driven" and "multitasking"?
Chisholm CD, et al. Acad Emerg Med. 2000.

Physicians performed a mean of 67.6 +/- 15.7 tasks per study period. The mean number of interruptions per 180-minute study period was 30.9 +/- 9.7 and the mean number of breaks-in-task was 20.7 +/- 6.3.

 

[turkeyjerky]

How many of those people died in the waiting room?

That's a good point. Maybe there should be a different metric for the patient who appears unstable or have typical chest pain vs some old lady who's been weak for a couple of days, or a 22 year old here for the 8th time this year w/ pleuritic chest pain.

I'm sure that it'll come along around the same time we develop a different type of stroke code for the patient with fingertip numbness vs someone w/ aphasia and hemiparesis...

 

[thegenius]

How many of those people died in the waiting room?

Well duh they don’t die in the waiting room because they are brought back immediately upon review of the EKG.

 

[TooMuchResearch]

Well duh they don’t die in the waiting room because they are brought back immediately upon review of the EKG.

You know what I meant.
If they sat out in the waiting room, do they have an adverse outcome or not? And if they don't get their speckle tracking or whatever the heck they do there, who has an adverse outcome?

 

[thegenius]

You know what I meant.
If they sat out in the waiting room, do they have an adverse outcome or not? And if they don't get their speckle tracking or whatever the heck they do there, who has an adverse outcome?

This will never be tested, for good reason. STEMI or near STEMI EKGs (like OMI) have pretty substantial risk of deterioration into....death. One thing is if they wait 20-30 minutes before coming back. But waiting several hours?

 

[GeneralVeers]

The big problem with EKGs is the nurses ordering them. I get why we do EKGs for Chest Pain as protocol due to not wanting to miss a STEMI and meet our door-to-cath times. Unfortunately the nurses are now getting them on every patient with any complaint of dizziness, shortness of breath, arm tingling, neck pain, upper back pain, abdominal pain and even hypertension. Probably 2/3 of these EKGs brought to me which interrupt my workflow are for BS, non-chest pain related complaints. I have had zero luck in getting the nurses to NOT order an EKG on a 23-year old female with asthma, audible wheezing, and complaint of "shortness of breath".

 

[WildcatS11]

The big problem with EKGs is the nurses ordering them. I get why we do EKGs for Chest Pain as protocol due to not wanting to miss a STEMI and meet our door-to-cath times. Unfortunately the nurses are now getting them on every patient with any complaint of dizziness, shortness of breath, arm tingling, neck pain, upper back pain, abdominal pain and even hypertension. Probably 2/3 of these EKGs brought to me which interrupt my workflow are for BS, non-chest pain related complaints. I have had zero luck in getting the nurses to NOT order an EKG on a 23-year old female with asthma, audible wheezing, and complaint of "shortness of breath".

Had a trauma recently, smart car vs minivan - lady had chest wall pain, ended up having a good amount of L sided rib fractures... but I basically had to rip the ekg machine away from the tech's hands to stop them from doing an ekg while we were doing a primary survey and FAST. The nurse kept telling her to do it. "But she said she has chest pain!"

 

[deleted109597]

I had to make them stop doing one on a pt in status. The charge nurse was like "It's SVT!" Yeah no kidding. However, it's atrial and it's because she's seizing. Give benzos. They pulled the patient advocate card on me.

 

[southerndoc]

The best unnecessary EKG reason I've ever heard was for a 20ish year old guy who had an abscess on his calf. I asked why we got it and the tech said "because he has a family history." I was formally complained on for being rude because my reply was "I have a family history. I don't get an EKG on myself every shift!"