Excitement and Ennui in the ED

It goes without saying some patient encounters are more energizing and rewarding than others.  As a corollary, some chief complaints similarly suck the joy out of the shift even before beginning the patient encounter.

This entertaining study simply looks for any particular time differential relating to physician self-assignment on the electronic trackboard between presenting chief complaints.  The general gist of this study would be that time-to-assignment reflects a surrogate of a composite of prioritization and/or desirability.

These authors looked at 30,382 presentations unrelated to trauma activations, and there were clear winners and losers.  This figure of the shortest and longest 10 complaints is a fairly concise summary of findings:

door to eval times

Despite consistently longer self-assignment times for certain complaints, the absolute difference in minutes is still quite small.  Furthermore, there are always issues with relying on these time stamps, particularly for higher-acuity patients; the priority of “being at the patient’s bedside” always trumps such housekeeping measures.  I highly doubt ankle sprains and finger injuries are truly seen more quickly than overdoses and stroke symptoms.

Vaginal bleeding, on the other hand … is deservedly pulling up the rear.

“Cherry Picking Patients: Examining the Interval Between Patient Rooming and Resident Self-assignment”

3 thoughts on “Excitement and Ennui in the ED”

  1. Not sure that the word "deservedly" is appropriate to describe why vaginal bleeding has the longest time to assignment. Residents and attendings alike already feel that the pelvic exam is not even part of the physical exam. I've seen far too many people procrastinate doing that exam for no other reason than it is inconvenient.

  2. I think "inconvenient" understates the pelvic exam. A detailed neurologic examination for dizziness is inconvenient. A pelvic exam is invasive, personal, and requires a chaperone. It has value in a certain set of circumstances, with limited +LR/-LR for various processes.

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