Tuesday, April 17, 2012

Meditation for Physicians

When stepping into a new patient's room, I must clear my mind completely.  To make a diagnosis, it's crucial to listen with 100% attention.  If I think about the patient I saw before, or what lab result I need to look up, my focus becomes divided.  One way to be more aware of the present moment is through meditation practice.

During medical school, Jon Kabat-Zinn lectured at the U. of Rochester and led us through various awareness exercises.  One exercise was to eat a raisin very s - l - o - w - l - y, savoring the taste and texture.  I still remember how potent the single raisin tasted.

Now, I've re-discovered him on the EM Tutorials Podcast  (By Drs Chris Cresswell, Qasim Alam and Andrew Dean-Ballarat, Australia and New Zealand)

I highly recommend you download # 7 Breath Meditation and give it a try for a week.  It's also FREE.

Monday, April 9, 2012


Once you've identified the time each patient spends at a certain step, you can identify which takes the longest.

NOW, you have identified the bottleneck.

Everything is dependent upon this bottleneck.  Recall the rate limiting step (RLS) in chemistry.  This step is typically a catalyst or rare substrate.  It's the process that S - L - O - W - S  everything else down.  In the ED, this may be: time to get a lab report, a 5150 bed, or the the on-call dialysis nurse.

Use a multi-perspective approach by including RNs, Techs, ICU docs, etc. to reduce the time it takes in the slowest step.  This can be challenging, but will reap huge rewards.

Lather, rinse, & repeat.

Monday, April 2, 2012

What are the important things to measure for ED flow improvement?

There are many metrics in the ED, ranging from patient satisfaction to % of Medicaid patients.   To improve patient flow and identify bottlenecks, there are 10 steps and times that should be measured:

1. Door to Triage
2. Triage to MD (assuming MD is in triage)
3. Bed to RN
4. Bed to MD
5. MD to Decision (DC vs. ADMIT)
   6) Imaging order to read
   7) Lab order to results
   8) Recheck of patient
9) DC to actually being out of ED
10) ADMIT to floor

If you add the total time of each of these steps, this equals total Length of Stay in ED (LOS).

Based upon the review of the time needed for each of step, an ED director can determine which areas need more effort and time to reduce the time in ED.  This is crucial because patient satisfaction is linked to the overall time in ED.