instructions and objectives
Instructions
- Complete course survey before first and after last shift and turn them in to ED Secretary.
- Check in on time with the ED charge nurse at the beginning of your triage and RN shifts, and with the Emergency physicians (EP) at the beginning of your EP shift.
- If you cannot make any scheduled shift, inform the ED charge nurse ASAP by calling ext 68705 and Dr. Sharp by email @ jsharp@lumc.edu .
- Triage shift – In triage, directed by and assisting the triage nurse.
- ED RN shift – In the ED, directed by and assisting the ED RN. You should be directly involved with all RN duties including assessments, general care, transport, IV access, observing EP assessments and interacting with physicians. Case-based reading of Emergency Medicine resources during this time is expected.
- EP shift – Assigned to an EP you will be performing H&P's without taking notes.
Objectives
- Professionalism – Develop awareness and sensitivity to the EP and ED RN perspective and the unique factors influencing decision making in the ED.
- Social context/continuum of care – Recognize why patients present to the ED and how they are processed; appraise the reasons for ED overcrowding and its influence on access and the healthcare system in general.
- Knowledge – Recognize underlying principles of triage, “prudent layperson” definition of an emergency and EMTALA.
- Communication – Perform appropriately focused and prudent assessments, presentations and documentation with attention to low probability/high risk etiologies.
- Patient care – Improve IV access and minor procedure skills, perform ABC's.
- Lifelong learning – Identify and access EM-based resources.
Assessment
Achievement of the objectives will be assessed informally by the EP's and the triage and ED RN's while they work and interact directly with the students and provide feedback during their three shifts. It will be assumed that students who actively participate as outlined above will have achieved the objectives. Students who do not engage in the process will be reported to Drs. Sharp and Fitz. Knowledge test questions will be added to the Ambulatory Medicine Clerkship written test. Required Readings :
- Iserson KV, Moskop, JC. Triage in medicine, part I: concept, history, and types. Annals of Emergency Medicine. 2007; 49: 275-281.
- Moskop JC, Iserson KV. Triage in medicine, part II: underlying values and principles. Annals of Emergency Medicine. 2007; 49: 282-287.
- Williams RM. The costs of visits to emergency departments. The New England Journal of Medicine. 1996; 334: 642-646.
- Croskerry, P. The cognitive imperative: thinking about how we think. Academic Emergency Medicine. 2000; 7: 1223-1231.
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