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How one ED mobilized his department during a mass casualty incident (2017)

epmonthly.com

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Re: How one ED mobilized his department during a mass casualty incident (2017)

#111

Post by romwell »

lostlogin wrote: post #10

I’m surprised reports were generated quicker when the radiologist worked with the X-ray tech. Back when I did x-rays, a quick radiologist could report a set of films in about a minute. I could X-ray 6 patients per hour (whilst doing data entry, billing, walking them to the room etc as well). I doubt I’d have been much more than twice as fast if the admin was skipped.

It's latency vs. bandwidth.

Reduced patient wait time (lower latency) was prioritized over how many X-Rays were processed per hour.

E.g. it wouldn't matter how fast the X-Ray specialist was working if the results were getting back to the patients in big batches, sent once an hour, because the patients might not live long enough to get them.

Re: How one ED mobilized his department during a mass casualty incident (2017)

#112

Post by somat »

ted_dunning wrote: post #109
somat wrote: post #76

Earlier quoted context omitted.

Makes me think of the apocryphal story that the genius behind Sears Roebuck & co, the thing that enabled them to change from being "just another mail order company" to "The mail order company" was to invert the fulfillment process. this changed the cost of assembling an order from n to log(n) I don't think it was Mr Sears or Mr Roebuck that came up with the idea, One of their warehouse managers I expect. I always sor…

What do you mean by "invert the fulfillment process"?

I think it is that instead of sending a boy around the store to assemble the stationary order, the assembler stays still, only responsible for what is in reach and the order moves on conveyor between assemblers.

Re: How one ED mobilized his department during a mass casualty incident (2017)

#113

Post by js2 »

andrei-akopian wrote: post #101
anamexis wrote: post #40

Earlier quoted context omitted.

You can also just click "past" under the post header.

That doesn't work. It plugs the title into hn.algolia.com which only returns the same thread. Shouldn't it search for the URL instead? Am I missing something? Also, I noticed the tracking parameters are in the URL of the old thread. Shouldn't the mods remove them using https://linkcleaner.app/ or something? I know the parameters are sometimes relevant but still...

This site doesn't get many submissions so you can search for it by site (domain address):

https://news.ycombinator.com/from?site=epmonthly.com

Re: How one ED mobilized his department during a mass casualty incident (2017)

#114

Post by somat »

trustinmenowpls wrote: post #80
somat wrote: post #76

Earlier quoted context omitted.

Makes me think of the apocryphal story that the genius behind Sears Roebuck & co, the thing that enabled them to change from being "just another mail order company" to "The mail order company" was to invert the fulfillment process. this changed the cost of assembling an order from n to log(n) I don't think it was Mr Sears or Mr Roebuck that came up with the idea, One of their warehouse managers I expect. I always sor…

I thought that law only required you to collect state tax, if you were out of state, local taxes were still exempt unless you had an actual business in that state.

It was South Dakota v. Wayfair, Inc. I was a sysadmin so only tangentially involved, but the programmers were having a hard time because the situation was basically unknowable, That is, there was no primary source of information, I think they ended up buying a service that specialized in keeping track of what address charged what taxes.

https://en.wikipedia.org/wiki/South_Dakota_v._Wayfair%2C_Inc.

The basic idea is that some localities charge a use tax, which is a sales tax applied to items bought outside their jurisdiction. The citizens if the jurisdiction are required to self report and pay this tax. The problem(or beneficent depending of what side of the transaction you were on) is that this is very nearly unenforceable, just too large an attack surface. The standard way to enforce tax payment is to move it a rung up the ladder. The store collects collects the sales tax before you get the item, your employer collects the income tax before you see the money etc. now there are exponentially fewer collection points. the collection points are hidden, out of the voter base and each point has far more to loose if they rebel keeping them in line.

Re: How one ED mobilized his department during a mass casualty incident (2017)

#115

Post by romwell »

lostlogin wrote: post #64
amluto wrote: post #24

Earlier quoted context omitted.

I recently accompanied a patient through an imaging lab. It was a room full of maybe 10 pieces of expensive equipment, and there was a big line of patients in a waiting room. There was one single technician, who handled one patient at a time, kept disappearing, and even when the technician was there, they spent more time convincing the machines to send the images to EMR than actually taking images. I estimated that t…

>I can easily imagine that skipping all the EMR integration and paperwork and just taking the pictures and having someone stand in the room and read the images would have gotten that 4x throughput improvement Yes. But 45 minutes later when someone wants to see the images ‘on that guy with the broken leg’ it becomes a nightmare. You need some labelling and a documentation system, and a unique identifier for each patie…

>Yes. But 45 minutes later

45 minutes later that person (or someone else) could be dead because paperwork created a choke point.

The trade off here, again, is reducing overall efficiency (bandwidth) to get the results that are needed now ASAP (latency).

Once the mayhem is over, those patients can have new X-Rays done the next day, the records can be sorted out the next week, etc.

How would you even justify it?

I'm sorry, ma'am, I understand you're in pain and dying after being shot, but waiting a few minutes NOW will really save us some time filing paperwork going forward.

Note that it's not just about the patients getting the X-Rays; with 250+ people arriving at the same time, any delay propagates with cascading effects and delays care for everyone.

Even non-critical patients waiting for their turn creates an issue, since space is limited.

Re: How one ED mobilized his department during a mass casualty incident (2017)

#116

Post by treflop »

ted_dunning wrote: post #108
treflop wrote: post #82

Earlier quoted context omitted.

I believe this is not a question that can be asked. Recently I pushed a change straight to production by myself with no approval and violated many rules but it saved us and carried us for weeks. Worse case if it broke, rollback would happen under in under 30 seconds. I did it because not only did I triple check, I’ve kept mental track of the number of regressions and issues that have been logged against all of my wor…

I once had an engineer push changes directly to production because they were confident that they would do it correctly. In fact, they were completely misguided about their own accuracy because they had systematically ignored or not understood the errors that they had made in the past. The challenge as a tech lead or manager is telling the difference between you and them. Or even telling whether you are them. My own t…

Your tendency may be that but the reality is my past companies want to ask me to contract for them after I leave, even 7 years later.

I uphold a certain quality of work and I expect my peers to do the same. Everyone makes mistakes but even mistakes can be modeled.

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