Start Strong, Finish Weak - Attending Shift Productivity

Start Strong, Finish Weak - Attending Shift Productivity

Attending physician productivity peaks at the beginning of the shift, starting with about 3 new patients in the first hour and decreases as the shift progresses.  This has important implications for staffing models.  Assuming a simple, uniform average over the shift won't work.

Private to Public ED Dumps Hurt Patients

Private to Public ED Dumps Hurt Patients

Failure of private hospitals to care for the uninsured resulted in informal ED to ED referrals, which meant up to 20% increased volume in public EDs for certain diagnoses, particularly orthopedic issues.  This led to duplicate testing, increased cost, complications, delays in care, and poor treatment of the most vulnerable patients.

Is There Such Thing as a Black Cloud?

Is There Such Thing as a Black Cloud?

There is no such thing as a "black cloud."  Those who self-identified as a black-cloud were also identified as such by their peers, but a look at the actual PED metrics showed no statistical difference except higher admission rate.  I'm not sure I believe this, but there you go...

Hey, Press Ganey - You Can't Improve What You Can't Control

Hey, Press Ganey - You Can't Improve What You Can't Control

Patient satisfaction is important.  But the most commonly used metric in the US, the Press Ganey survey, may not be a good measure of individual emergency physician and clinician performance.  Giving emergency clinicians feedback on their Press Ganey scores, ostensibly so they could take steps to improve, did not lead to appreciable score improvements.

Ondansetron in the WR Reduces IV Fluid

Ondansetron in the WR Reduces IV Fluid

Triage nursing protocols that allowed early use of ondansetron and oral fluids significantly reduced the number of children who needed IV fluid without prolonging length of stay.

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