My first day with an EMR

Is tonight (Friday night).  Our overnight shift, which on a Friday night can run from busy to very very busy.

The ‘switchover’ is at midnight, though for various technical reasons we won’t be fully electronic until after 3AM, so it’ll be a mixed environment of paper and electrons.  I volunteered for this shift, so it’ll be a lot of fun.

I am cautiously optimistic, and we’ve given ourselves a big advantage: we’ve doubled up on scribes and we’ve “borrowed” them from places that already use the EMR (we’re on Epic, but it could be any system), and that should ease the transition.  That, plus all the official tech helpers coming for the first 15 days.

We’re pretty well prepared for this, though it’s been described as starting a new job: I know the medicine but the ‘how’ and the ‘what are the cues we’re done’ are different.  It’s billed as being mildly or very inefficient, though that’s supposed to get better with experience.

I’ll let you know.

Update: The transition wasn’t smooth.  There were much longer delays at each step that had been anticipated, the end result of which was the our 4AM doc was really the first doc to see the majority of their patients on the EMR.

It didn’t help that the ED was a total zoo.  People will not stop having emergencies for us to smooth over our little technical problems.  Imagine.  (Yes, that was sarcastic, DWL).

Movin’ Meat: Clout

Movin’ Meat: Clout

Shadowfax is correct here: Organized Medicine has no clout.  The ablilty to ride the coat-tails of politically popular programs, yes, but no actual clout.

Read Movin’ Meat should you disagree.

A New Sign in medicine: the Tim Russert sign

Mr. Russert has a negative stress test on April 19th and died suddenly of a heart attack on June 13th.

I therefore propose a new sign in medicine, the Tim Russert sign: death (or MI) shortly after a negative stress test.

Newsweek: Top 10 First Aid Mistakes Thank heavens for emergency rooms. But sometimes the first aid measures taken on the scene before a patient arrives at the hospital can make all the difference, especially if the ER is crowded. (On average you’ll wait 45 minutes before seeing a doctor, according to the Centers for Disease Control, and longer in urban centers.)

We asked two experts, Dr. Tom Scaletta, the outgoing president of the American Academy of Emergency Medicine, and Denise King, president of the Emergency Nurses Association, to identify the 10 most common first aid mistakes—and what you should do instead.

Not bad as generic advice goes; interesting that all but one end in “go to the ER”. Even the one that needs a dentist.