Layered evaluation
I am so using this concept in future work. In this blog post, an ER doc answers the question of an ICU nurse who asks "Do you always assess everything about all patients who come to the ED"?
The short answer is "no", of course; otherwise the wait would be 10 times what it already is. The long answer, though, is excellent, and expresses one of the core concepts of emergency medicine perfectly:
One strategy we use is that of layered evaluations. The first point of contact for a patient is triage, and the triage RN does the first assessment to get a sense of sick-or-not-sick, and risk factors for Badness. Then there is the primary nurse who does a more detailed assessment, then the doctor. At any time there is a possibility the person doing the assessment will redirect the care flow. The chest pain sent back to the cardiac area of the ER might be seen by me and I may cancel all the labs because it's clearly just a broken rib, or conversely, the Fast Track nurse might kick a patient out of Fast Track to a more acute zone if she realizes that this is worse than it was billed initially.
So when you're in the ED and people are asking you the same questions over and over again, consider this concept before you get all annoyed about having to answer them *again*. Layered evaluations, I love it.
The short answer is "no", of course; otherwise the wait would be 10 times what it already is. The long answer, though, is excellent, and expresses one of the core concepts of emergency medicine perfectly:
One strategy we use is that of layered evaluations. The first point of contact for a patient is triage, and the triage RN does the first assessment to get a sense of sick-or-not-sick, and risk factors for Badness. Then there is the primary nurse who does a more detailed assessment, then the doctor. At any time there is a possibility the person doing the assessment will redirect the care flow. The chest pain sent back to the cardiac area of the ER might be seen by me and I may cancel all the labs because it's clearly just a broken rib, or conversely, the Fast Track nurse might kick a patient out of Fast Track to a more acute zone if she realizes that this is worse than it was billed initially.
So when you're in the ED and people are asking you the same questions over and over again, consider this concept before you get all annoyed about having to answer them *again*. Layered evaluations, I love it.