For some reason I choose options that lead me to talk alot, get more information from the patient, and really try to determine if the cough is bronchitic, GERD, asthma, URI, PNA, or whatever else. And I think it's largely a waste of time.
I don't think it's a necessarily a waste of time. Pts feel like you cared, spent time with them, were thorough in your evaluation, and you're more likely to get the points you need to code an adequate chart. Also, you are probably more accurate at seeing why the pt came (wants an xray, brother had lung CA, has no PCP, couldn't sleep, etc). This helps with pt complaints and satisfaction. I am one of the faster ones in my department. Numbers-wise, I was also in the faster group in residency. I have noticed that all of the slower guys have the same bad habits. Talking to the pts and spending time in the room is
NOT one of them.
Here is a list of things that I have noticed the slow ER doctors do:
1) The do not get in the room quickly. Except for times when I am stuck in a room for a procedure or resuscitation, I almost always know what is going on in the dept or the pod for which I am responsible. I know almost instantly when a pt is being brought back. Some guys think that signing up for the pts in the EMR counts. NO, IT DOESN'T. You still actually have to go into the room and begin your evaluation. I have seen some guys wait 20 minutes after signing up before they go into the room.
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2) They order things in series. In your example, you don't want to order an xray and then decide they need blood work, and then noticed they are tachycardic and maybe have a PE. Decisions should be made upfront, as you walk out of the room. For the most part, if I think someone is sick enough for an xray, then they are prob bad enough for blood work. Sure, there are times when I will order an xray and then add blood work if the xray shows a large infiltrate. But one, those times are rare (usually I ordered the xray just to make someone feel better). Two, I am waiting for that xray like a hawk! I will look for that xray as soon as the pt returns from radiology. I don't just notice an hour later that the xray was abnormal.
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3) Once all diagnostic studies are complete, the slower doctors almost refuse to make a decision. For me, as soon as the CT, blood work, xrays are back, I make a decision. The pt needs to be discharged or admitted. You can't just let them sit there.
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4) They don't know where the hangups in their department are. Urines take forever. Before the pts get strapped down to an IV pole, I make sure they go to the BR. If I see urine sitting on the counter, I ask a nurse to send it to the lab. CBCs usually get done quickly. If I start seeing BMPs and troponin results without a CBC, I know something got lost, clotted off, was hemolyzed, etc. Or sometimes only part of the BMP gets resulted, I know then that something went wrong. I get proactive and ask the lab or the nurse about it. A slow doctor will just keep on waiting until everything is back. They only notice these delays when their shift is almost over.
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5) They don't put things on autopilot when they can. For migraine HAs, I order meds, then put the discharge order in. That way, the nurse knows this person needs to go home. Sure, I will come back about 10-15 min after the pt receives the meds and make sure they are better. But this way, scripts are already there, dc papers are printed by the RN and ready to go. Otherwise, what happens is you recheck the pt, then put the orders in, then the RN has to actually realize that a dc order is in, then the papers get printed, then the RN goes to lunch first, then the pt is released. Any number of things can disrupt and delay this process. All of this can add anywhere from 30 min to an 1hr to time in the department. Same goes for back pain. If you walked in with back pain and somehow managed to convince me to order a "shot," then the medication and discharge orders are put in at the same time. If a pt needs a splint or a lac repair, then I put the discharge order in and tell the RN don't release the pt until the PA does the procedure.
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The numbers I put above are conservative. Some of those delays can be an hour. If you add it up, that's 1.5 hrs saved by being more efficient, proactive. Talking to the pt too much should be the least of your concerns.