Key High‐efficiency Practices of Emergency Department Providers: A Mixed‐methods Study

Bobb, Morgan R.; Ahmed, Azeemuddin; Heukelom, Paul Van; Tranter, Rachel; Harland, Karisa K.; Firth, Brady; Fry, Randy; Schneider, Katherine A.; Dierks, Kathryn K.; Miller, Sarah; Mohr, Nicholas M.

doi:10.1111/acem.13361

Cited by 15 publications

(20 citation statements)

References 26 publications

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“…The skill required for managing busy and complex systems are undoubtedly important for attending emergency physicians (EPs), but these skills are currently heterogeneously taught. While there is new and intriguing evidence around EP efficiency, 18 there is still little by way of formal teaching reported within our current study. However, it is not surprising that a fair number of informal and experiential in situ instructional methods have crystallized under the increasing pressures of overcrowded ED systems.…”

Section: Discussionmentioning

confidence: 61%

Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department

Chan

Dewark²,

Sherbino

et al. 2018

AEM Education and Training

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Background: Busy environments, like the emergency department (ED), require teachers to develop instructional strategies for coaching trainees to function within these same environments. Few studies have documented the strategies used by emergency physician (EP)-teachers within these busy, chaotic environments, instead emphasizing teaching in more predictable environments such as the outpatient clinic, hospital wards, or operating room. The authors sought to discover what strategies EP-teachers were using and what trainees recalled experiencing when learning to handle these unpredictable, overcrowded, complex, multipatient environments. Method: An interpretive description study was conducted at multiple teaching hospitals affiliated with McMaster University from July 2014 to May 2015. Participants (10 EP-teachers and 10 junior residents) were asked to recall teaching strategies related to handling ED patient flow. Participants were asked to describe techniques that they used, observed, or experienced as trainees. Two independent coders read through interview transcripts, analyzing these documents inductively and iteratively. Results: Two main types of strategies to teach ED management were discovered: 1) workplace-based methods, including both observation and in situ instruction; and 2) principle-based advice. The most often described techniques were workplace-based methods, which included a variety of in situ techniques ranging from conversations to managerial coaching (e.g., collaborative problem-solving of real-life administrative dilemmas). Conclusions: A mix of strategies are used to teach and coach trainees to handle multipatient environments. Further research is required to determine how to optimize the use of these techniques and innovate new strategies to support the learning of these crucial skills. E mergency department (ED) crowding is a persistent international phenomenon. 1,2 Concurrent management of multiple ill patients is a vital skill in emergency medicine (EM), especially given increasing ED patient volumes 3,4 and acuity. 5,6 Recently, research has led to a proposed conceptual framework for physicians' thinking in such complex multipatient environments; 7 however, there is little formal teaching or faculty development around these skills in EM. 4 With the advent of graduated responsibility models such as

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Section: Discussionmentioning

confidence: 61%

Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department

Chan

Dewark²,

Sherbino

et al. 2018

AEM Education and Training

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“…Much of the previous literature on clinical productivity described system-based approaches rather than individual-based strategies [6-9]. Few articles have formally examined clinical productivity best practices among practitioners in the emergency department [10,11]. While our methodology was more formal, many of the themes identified in our study overlap with those found in the literature.…”

Section: Discussionmentioning

confidence: 90%

“…We sought to develop a greater understanding of the efficiency strategies that these EPs used to function at such a high level. Unfortunately, previous productivity studies in emergency medicine have focused on department-wide efficiency [6-9] and only rarely have provided guidance on improving individual productivity [10,11].…”

Section: Introductionmentioning

confidence: 99%

How I Work Smarter: A Qualitative Analysis of Emergency Physicians’ Strategies for Clinical and Non-clinical Productivity

Azan

Innes

Thoma

et al. 2019

Cureus

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Introduction Emergency physicians’ (EP) clinical and professional non-clinical environments can be stressful and lead to burnout. However, some EPs thrive in these environments. To date, there is limited research investigating the strategies that successful EPs use to be maximally productive. Methods A snowball sampling technique was used to identify peer-nominated EPs who were, within their community of practice, subjectively felt to be successful and efficient. Participants answered a standardized set of questions addressing their efficiency patterns that were published as part of the “How I Work Smarter” blog series on the Academic Life in Emergency Medicine website. Two reviewers performed an inductive qualitative thematic analysis to code and summarize their responses and develop a thematic framework that described patterns of EP productivity. Results Two themes, communication and efficiency, were applicable in the clinical and non-clinical arenas. Location and environment was a major theme in the non-clinical arena. The themes task management and prioritization, tools for wellness, and motivators spanned both environments. Each theme included several strategies that were felt by the respondents to improve productivity and efficiency. Conclusion We described a thematic framework of productivity strategies for EPs that may increase productivity, improve work-life balance, and decrease burnout. EPs interested in increasing their efficiency both within and beyond the clinical area may consider adopting these strategies.

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“…13 It has been suggested that when first names are used, teams work more efficiently and that this has positive implications for patient safety. 14 Root cause analysis has demonstrated up to 70% of adverse events are due to communication failure. Medical and nursing teams already recognise this; in one survey, two-thirds of staff felt communication was the most important factor in improving efficiency and safety.…”

Section: Discussionmentioning

confidence: 99%

What's in a name: How do junior doctors address their consultants?

Graham

Messer

2020

Clinical Medicine

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Evidence has suggested that when senior doctors are less approachable, junior staff are less likely to raise safety issues. There are limited existing data on whether the name by which junior doctors address their seniors reflects approachability and if this varies between grade and specialties. Methods An online survey was conducted in a large teaching hospital. Respondents were asked about their use of first names when addressing consultants and whether they felt this reflected their perceptions of the consultants' approachability. Results Four-hundred and twenty-three responses were received from a cohort of approximately 800 junior doctors. Of these, 410 were included in this analysis. Respondents came from 57 different subspecialties and all years of training. Overall, junior doctors addressed 43% of consultants by their first name; 71% of junior doctors perceived these consultants to be more approachable. There were significant differences in the results between grades and specialty of junior doctor. Conclusion Throughout all specialties, the majority of junior doctors consider the consultants that they address informally to be more approachable.

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Key High‐efficiency Practices of Emergency Department Providers: A Mixed‐methods Study

Cited by 15 publications

References 26 publications

Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department

Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department

How I Work Smarter: A Qualitative Analysis of Emergency Physicians’ Strategies for Clinical and Non-clinical Productivity

What's in a name: How do junior doctors address their consultants?

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