Teamwork in the ED
Teamwork in the ED
Melissa Kloote, MS, PA-C
Working in the ED, in any capacity, is a team sport. While, as a provider, sometimes we think and feel as though we are “doing all the work”, the roles of the other providers, nursing staff, techs, secretaries, and even environmental services are vital to the patient’s course and experience during their visit. There are many things we can work on to improve efficacy and function with maximized efficiently in our shops:
1) Communication is key. Always. For every position in the department, you’ll find that communication is often your best asset. From the moment a patient walks through the door and you begin to assess, it is useful to give even the briefest of summaries to the nurses about what your plans for the patient are. It actively takes away confusion when you order a different work-up than the nurse was expecting (because, as you know, often the patient’s complaint is different then what they originally stated in triage). Keeping other team members in the loop helps to provide a smoother ED flow from the team and the patient.
2) Respect. Of course, there is a known hierarchy in the ED — everyone looks up to and respects the attendings. When something goes wrong, it doesn’t take long before “Physician made aware”. But everyone that works in the ED should be respected. The roles of everyone there is vital to the ED running efficiently, and that includes the environmental staff, techs, secretaries, nurses, and other providers. Everyone that you offer respect to will likely return it, and if you ever need anything in the future — it is much easier to ask when you’ve been kind to them prior.
3) Discuss a topic other than work. Working in our specialty is extremely stressful. I have been a provider for years and I still have days where I don’t have the time to even eat during a shift. But, on those occasions where you do have an extra minute or two, it’s nice to discuss something other than work with coworkers. I recommend it be a positive topic, like a recent sports game, or something that you have in common with your colleague. We can show others that we are normal people, that we are approachable, and that we have things to talk about other than just work. Be interesting to work with!
4) Have a question? Just ask. One of the downfalls in emergency medicine is that everyone expects you to be always correct- both the patients and your attendings. When you are right, you are doing what was expected, and when you’re wrong — you’ll hear about it after the bounceback (or if they find something during chart review). It is often easy to ask questions when working with “nice” attendings. They don’t question your knowledge. but often like to tactfully probe to find its limits and then discuss the topic at hand. When you’re working with a “not-so-pleasant” attending, we can be intimidated, and instead of asking questions… we make decisions on our own. When you stop to think about it, the attending probably isn’t a terrible person (despite what you might think that second), and at some point, they made the conscious decision to teach at an academic facility — so they likely wanted to work with new doctors and possibly be a vital part of their learning process. We often have no idea what that attending’s outside situation is like, their prior struggles, or what is making them irritable, but again, don’t be afraid to ask questions at the risk of looking “dumb” — the main priority is always patient care.
5) Don’t be defensive if you’re wrong. There will be plenty of times when you make mistakes in the ED. Most of them are accidental and hopefully will not harm patients. I cannot tell you how many times I’ve entered in an inadequate medication dose, put in orders on the incorrect patient, or even missed some key differentials. If you’re lucky, you’ll be able to put orders in diligently every time, on every patient. But unfortunately, that is not the case in a busy ED. Fortunately, we have nursing staff to constantly check our orders before fulfilling them. If you entered an order wrong, and someone tells you, accept it! If you miss a diagnosis – learn from it! You’ll remember every time you were wrong and hopefully remember to order correctly and/or improve your reasoning next time. It happens to everyone, so accept it and move on.
6) We have the same intentions overall: quality patient care. At the end of the day, hopefully everyone in EM entered the field with altruistic intentions. Despite working with different personalities of patients and staff, hopefully you remember most patients that are coming to you are afraid because something is going on that they don’t understand. It is all our jobs to make the patient feel comfortable and respected. We must do our best to figure out the cause or how to get the patient where they need to be for appropriate treatment.
Written by: Melissa Kloote, MS, PA-C