Ready–Fire–Aim (The Emergency Medicine Dilemma)

The Emergency Department is often accused of over ordering tests and shot gunning our approach to patient care (most over utilization involves radiographic procedures on hours the radiologist is not in house!). This is the only thing we have to offer to critically ill patients. Emergency Medicine is one of those specialties where we shoot from the hip when we have patients critically ill with minimal knowledge of what is going on. I suspect we will always take criticism from our medical peers over this issue.

There are some instances when we can in fact focus our treatment plan. Recently we have seen a marked increase in the use of ultrasounds in Emergency Medicine. Using ultrasounds for a quick look at a gallbladder will obviate the need for multiple tests to make a diagnosis of colelithiasis/acute cholecystitis in the Emergency Department. The same is true for ectopic pregnancies and even DVT’s. These are often processes that take tremendous amount of time when we are waiting for staff to perform these procedures on off hours. Indeed, in the majority of hospitals, the technicians have to be called in. A more steady approach to the patient’s care is either calling in these individuals early or a direct ultrasound by the provider. This will have a huge impact on the efficiency of the Emergency Department as well as provide us an opportunity to aim and then fire.

Outside of such focused issues, the Ready-Fire-Aim approach to Emergency Medicine will always exist. We are not afforded the luxury of multiple tests and time to determine what is wrong with all of our patients. Many times acting in a vacuum is better than not acting at all.