With ED boarding, the burden of sign-out patients is greater than ever. This study shows just what I expected. All of these sign-out patients negatively affects how many new cases each resident is able to see on each shift.
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.
This opinion piece suggests that it may not only be the clunky EHR that is to blame for physician burnout. Rather, meaningless government documentation requirements pack our notes with useless information that we must include nonetheless in order to get paid.
One percent of patients presenting with acute alcohol intoxication eventually needed critical care admission. Be wary of abnormal vital signs, hypoglycemia, or the need for additional chemical sedation, as these were associated with an increased odds of needing the ICU in such people.