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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, December 27, 2015

Tips para mejor eficiencia clínica

ACEP Now - By Kevin M. Klauer on July 15, 2015 
"The more complex the delivery of emergency medical care becomes, the more critical it is that we find ways to become lean, mean EM machines. Recently, I worked a day shift and was in a comfortable pace, but I noted a steadier volume at 7:30 a.m. than usual. I checked with one of the nurses, making certain the patient in room 10 had received his ice and ibuprofen and was on his way to radiology. She responded, “Why are you in a hurry? We aren’t that busy.” My response was, “How efficient we are now will dictate how we will handle our increased volume later.” We can’t always predict how many patients we will see or how they will be distributed during our shift, but we do have control over what we do with those we already have. From my perspective, there should be two speeds in the ED: off and on. Slipping into slow mode during lulls in volume can be a disastrous strategy. Efficiency results in increased productivity, improved patient safety, happier staff, satisfied patients, and preservation of your sanity. 
Through interactions with others and my own experiences, I’ve compiled the following list of efficiency principles that you may find useful." 
  1. Identify the decision and work toward it. Every step must bring you closer to your decision point. 
  2. High volume will drive your efficiency out of necessity, but low volume can tease you into relaxing too much, making you become inefficient. 
  3. Establish expectations up front with patients and staff. 
  4. Advise nursing of your plan. 
  5. Avoid holding pattern tests. 
  6. Limit interruptions. 
  7. We’ve all heard the phrase “time is money.” Well, in the ED, money isn’t our currency—time is. 
  8. When the decision has beenreached, execute. 
  9. If the decision will be the same regardless of the results, don’t order the test. 
  10. Tell people the value they are getting by trading tests for your expertise. 
  11. The weakest diagnostic link is the slowest test you order and can nullify the value of point-of-care testing. 
  12. Employ patient-centered care and shared decision making. 
  13. Plan your shift. 
  14. Avoid diagnostic pathophysiology.