Thursday 14 February 2013

Battle Preparation 2: The Buddy Shift

This is the 2nd part in the Battle Preparation series by SOCMOB guest blogger Damon Tedford.

In part 1, we looked at a checklist of items that new learners and staff should identify and examine prior to their first shift in a new ED.  Today we will be looking at the critical questions to ask on your buddy shifts before venturing off alone in your new ED.  These posts are most oriented to the level of senior residents who will become new staff physicians in the near future.  However, the checklists will also be very beneficial to anyone entering a new department, including nurses, junior residents, respiratory therapists, etc.  The ability to find proper equipment is more important than the proper strategy in dealing with a problem.  Amateurs discuss strategy, experts discuss logistics.  

Important questions in this document include:
- What radiology tests do I have access to, and at what times of day?
- How do I set a patient up for outpatient antibiotic therapy?
- Is there a crisis worker for psychiatric patients or do I see them first?
- What are the expectations in our group for shift handover?
and many more...

Let me use a story to emphasize the importance of logistics versus strategy.  A few months ago on a CCU rotation, I was managing a chest pain patient in the ED.  He had hyperacute T-waves on his ECG.  It was about 2 AM, the ED was packed, and it would be about 45 minutes until he could get to the cath lab.  In the meantime, he required management of his chest pain and a nitroglycerin infusion had been started at 10 mcg/min.  His nurse was only intermittently in the room, so frequent titration of his nitro would have been impossible unless I knew how to do it myself.  Fortunately, I had made sure to learn to use our IV pumps; thus I could quickly increase his nitro infusion independent of nursing staff requirements.
This same concept applies to everything you do in the ER; from inserting a urinary catheter to preparing a patient for inter-department transport.  Self-reliance and total logistic knowledge of your environment is a must.  Pretend you're an anesthetistHave you ever seen an anesthetist who didn't set up his/her own pumps or draw up his/her own meds?

Here is a link to part 2 of the Battle Preparation: Buddy Shift Questions


Damon Tedford (@DamonTedford), Chris Krause and Chris Bond (@SocmobEM)

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