Deuteronomy and the Practice of Emergency Medicine

Are you familiar with the book of Deuteronomy in the bible? This is the chapter describing lineage: “so and so begat so and so, who begat … and on and on”. Many ED physicians practice Emergency Medicine the same way. One test is ordered. When the test results are back, this prompts them to order another test and then perhaps a third test in the sequence. In Emergency Medicine management, time and real estate are two of our most precious and limited resources. We need to focus on efficiency and creating empty beds. If we do not empty beds out, we can’t move patients out of the waiting room into beds and we become gridlocked. There are many processes to study and indeed, many programs to utilize (eg: Lean Processes in the ED), but none will substitute for efficient patient management once the patient reaches the provider.

Order the test or tests that will help you reach a decision point in your care. Perhaps it is sometimes criticized as a “shotgun” approach, but it is not. The decision of which test to order is not random. It is based on your clinical evaluation of the patient and it helps guide you toward focusing your attention on the right test.