Seeing multiple EDs across the province closing represents nothing short of a crisis.
These EDs and ICUs were built for a reason and to imagine we are now closing them despite rising volumes and demands leaves me speechless.
Here's a 🧵 on crisis management
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These EDs and ICUs were built for a reason and to imagine we are now closing them despite rising volumes and demands leaves me speechless.
Here's a 🧵 on crisis management
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In my job as a trauma physician, I regularly face crises and manage uncertainty.
There are several key principles we teach in crisis management & decision making that would be helpful to apply to our HC system. I’ll outline 4 in the thread below.
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There are several key principles we teach in crisis management & decision making that would be helpful to apply to our HC system. I’ll outline 4 in the thread below.
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1. Crisis declaration: The team leader must declare that an emergency/crisis is occurring. Sounds simple and intuitive but yet I have yet to hear this from key decision makers. When we’re faced with a critically injured patient, the team lead states something to the effect
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“this patient is critically injured with ongoing hemorrhaging causing hypotension”.
A declaration that our healthcare system is in crisis is essential. Everyone must have a shared mental model of what is happening, effectively ensure we're all on the same page.
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A declaration that our healthcare system is in crisis is essential. Everyone must have a shared mental model of what is happening, effectively ensure we're all on the same page.
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Further actions are virtually impossible without this because people will not understand key priorities. If we look back to the early days of #COVID, we all knew where our healthcare leaders stood with priorities…under all circumstances the goal was to preserve capacity in
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the EDs and ICUs…I don’t even know what’s happening anymore.
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2.Be clear & transparent with communication. It’s entirely possible that I won’t know the cause initially for why the patient is unstable. So I will explicitly say “The patient is unstable, I’m not sure why".
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Then ask my team..."What am I missing?”.
This engages the rest of our team to speak up. In our HC system right now, its ok for leaders not to understand all the nuances leading to our crisis, but it is essential to open lines of communication. Listen and learn.
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This engages the rest of our team to speak up. In our HC system right now, its ok for leaders not to understand all the nuances leading to our crisis, but it is essential to open lines of communication. Listen and learn.
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There will be key insights that are gleaned from frontline clinicians and patients. Some things can't be addressed immediately but other elements can easily be actioned on.
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3. Become hyperfocused on 2-3 key priorities. This is usually set by the team leader.
When an injured patient is bleeding, we have typically 3 priorities:
1) stop the bleeding
2) replace blood loss and
3) fix other physiologic abnormalities
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When an injured patient is bleeding, we have typically 3 priorities:
1) stop the bleeding
2) replace blood loss and
3) fix other physiologic abnormalities
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We don’t worry about anything but the immediate threats to life.
The same should be done in our healthcare system.
There certainly are lots of problems but people will face significant harm with ED and ICU closures. This has to be the near term priority over all else.
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The same should be done in our healthcare system.
There certainly are lots of problems but people will face significant harm with ED and ICU closures. This has to be the near term priority over all else.
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4.Make an initial first step that prioritizes safety, enough to buy yourself time to consider other options and analyze the problem more deeply. We pre-script our first 5 minutes or few steps. It becomes automatic.
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Once the patient stabilizes, after the blood pressure stabilizes, the patient has been intubated then we take a breath.
We discuss, regroup and update our plan.
We’ve bought ourselves a few moments to thinking more thoroughly and engage the entire team for our next steps
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We discuss, regroup and update our plan.
We’ve bought ourselves a few moments to thinking more thoroughly and engage the entire team for our next steps
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In HC …the next steps should likely be to keep all EDs and ICUs open. What are the key steps to make that happen?
Staffing is likely a keystone issue. Maybe there’s 1-2 other components. Identify those. Now!
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Staffing is likely a keystone issue. Maybe there’s 1-2 other components. Identify those. Now!
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Once that is happening then we can collectively look more deeply at the rest of the system. But if people are facing harm or dying because they can’t access care under life threatening circumstances
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then we’re certainly not in a position to be able to manage the elective & non-urgent aspects of patient care.
Hard to manage hypertension or replace joints when we can't help those who are near death.
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Hard to manage hypertension or replace joints when we can't help those who are near death.
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So, in summary:
1. declare the crisis
2. use transparent communication
3. hyperfocus on 2-3 priorities
4. Make a safe & quick first decision to buy time
We can't afford to wait.
END
1. declare the crisis
2. use transparent communication
3. hyperfocus on 2-3 priorities
4. Make a safe & quick first decision to buy time
We can't afford to wait.
END
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