H E A L T H L A W Strategies on Responding to Variable Patient Acuity and Flow ■ JOHN SHUFELDT, MD, JD, MBA, FACEP O ver the years, I have worked with a variety of providers who exhibited significantly disparate skill levels in their ability to manage patient flow. Practicing good medi- cine is a given; some have been amazingly intelligent providers who make House look like a PG1 psychiatry resident from a non-accredited medical school. Their only downside was that they were pathetically slow, or communicated at the level of a mollusk. Effective and efficient providers share the ability to com- municate, to work efficiently in a team environment, and to multitask—all while rapidly identifying and solving the prob- lems of large and varying acuity patient loads. Such efficiency is highly respected, yet rarely taught, and can actually improve the care you administer and, thus, help minimize your liability exposure. Greater physician efficiency leads to improved patient sat- isfaction; better patient flow (patients/hour) diminishes wait times. Improved efficiency also cuts down on wasted time (and its energy-draining properties), allowing more time to focus on seriously ill patients and reducing the risk of medical errors. Finally, enhanced efficiency goes hand-in-glove with im- proved teamwork and increased employee satisfaction. This, in turn, leads to lower turnover and an overall more positive workplace. Enhanced efficiency can be attained by focusing on three specific strategy categories: physical, cognitive, and patient disposition. Physical Strategies Carry the appropriate gear. You don’t need to be outfitted like John Shufeldt is the founder of the Shufeldt Law Firm, as well as the chief executive officer of NextCare, Inc., and sits on the Editorial Board of JUCM. He may be contacted at JJS@shufeldtlaw.com. 38 a SWAT team member, but you should have the “obvious” gear close at hand: stethoscope, pen, trauma shears, and eye protection. You can also use your shears or stethoscope end as a reflex hammer. In addition, keep in mind three key words before each pa- tient encounter: Ⅲ Document. If you are using an EMR, bring the computer tablet into the room with you, as you would a paper chart, for efficient reference and documentation. This also makes the patient believe that you have their data close at hand. Ⅲ Complete. Complete the record while talking to the pa- tient and explaining the treatment plan. In other words, multitask. Listen while writing or typing. Ⅲ Anticipate. Ask the patient if they have any additional questions before you exit. Use technology effectively. We all know how frustrating it is to hear a patient say, “I don’t what they said or what they put me on.” Don’t make a patient’s primary physician suf- fer the same fate. Have electronic, modifiable discharge summaries and follow-up instructions on hand to send home with the patient. PDAs allow point-of-care searching for interactions, drug doses, and procedures. Newer models may include a digital camera suitable for medical photography. Resist the tempta- tion to abuse such technology, however; recently, a fifth-year surgical resident at the Mayo Clinic used his PDA to snap a picture of a patient’s penis with the phrase “HOT ROD” tat- tooed on it, then sent the pictures to his friends. He is now available to cover urgent care shifts, if you need some help. In-house laboratory investigations can also streamline your time with the patient. Having the results of urinalysis, CBC, and other tests on the chart prior to entering the exam room will allow you to make a one-stop disposition. Choreograph your movements. Think of the water-ballet scene in Caddyshack; choreograph group tasks, and plan your route through the center. If standing orders are used, first JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | D e c e m b e r 2 0 0 8 w w w. j u c m . c o m