Thread by @Dr_Oubre

Do you feel overwhelmed by cross coverage at night?

You need a framework to stay organized.

Here are 5 tips to thrive in these high stress situations:

The problem?

🔶 You might be 1 person covering admits and floor patients you don't know.
🔶 This is a high stress situation.
🔶 A framework allows you to provide better care.

Let's dig in ⤵️

Tip #1️⃣ Determine acuity

Did 5 pages just come through at once?

Get the info from ALL of them asap
(& have a system... more on this later)

Why?

You might waste 5 minutes replacing electrolytes on the first 4 but that 5th patient is decompensating.

Tip #2️⃣ Triage (Who needs YOU right NOW)

That admit has an ER doctor. That floor patient does not.

See the floor patient whose only coverage is YOU.

Also, if a nurse is concerned, err on the side of seeing the patient yourself vs managing over the phone.

Tip #3️⃣ Stabilize first.

You may get overwhelmed & distracted with diagnosing a decompensating patient.

But what they need most is stabilization.

With experience, you'll learn to do these concurrently.

Example:

Someone in respiratory distress with dropping O2 sats...

🔶 Can this be managed with an increase in supplemental oxygen or not?
🔶 Do they need transfer to the ICU?
🔶 Do they need to be intubated?

Ask these questions first.

Experience will help you determine sick vs not sick.

Tip #4️⃣ Do something.

This is especially for new NPs, PAs and interns.

Inexperience may lead to paralysis by analysis.
But you know more than you think!

🔶 Gather data.
🔶 Make an assessment.
🔶 Enact a plan.
(More on presenting patients later)

Why do SOMETHING?

Doing SOMETHING will give the day team a data point.

Example:

Gave 40mg IV lasix... No response.

Well either that patient needs a higher dose of lasix or its not pulmonary edema.

That is a data point the day team can use to further manage the patient.

Tip #5️⃣ Stay organized.

Back to tip #1, things can happen all at once.

Have a system to stay organized so you can come back to lower acuity patients once things calm down.

This system decompresses your cognitive load.

How?

Your brain is like an internet browser....

When you have a lot of tabs open it runs slowly.
Closing the tabs allows it to run faster.

Having a system ➡️ less cognitive load = closing tabs ➡️ clear mind

I'm a fan of pen and paper👇

https://twitter.com/2284420200/status/1571129883396395015

✨Bonus Tip✨: Presenting to upper level / supervising doc

Don't just ask, "What should I do?"

You MUST practice gathering data, making an assessment and coming up with a plan.

THEN present this info / plan to your senior.

This will refine your process + give you confidence.

In summary:

1️⃣ Determine Acuity
2️⃣ Triage (who needs YOU right NOW)
3️⃣ Stabilize first
4️⃣ Do something
5️⃣ Stay organized
✨Bonus ✨: Present a PLAN to your supervising doc

That's a wrap!

If you enjoyed this thread:

1. Follow me @Dr_Oubre for more of these
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