21–30 of 116 posts
Do paramedics/ambulances shard across hospitals? It looks like there’s 3 hospitals within 15 minutes of the Las Vegas strip, I’m curious if there’s any attempt to allocate patients equally so that no single hospital becomes overwhelemed.
Interesting that he had to do so much thinking and improvising. I'm an EMT in Belgium, and every hospital here has to have plans for mass casualty events. Ambulance bays are built to be transformed into a triage ward, spare beds are kept close, often there's a dedicated command room, ...
The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.
Requiring people to double check that someone gets the right meds is super important 99% of the time. Having a radiologist review x rays asynchronously is more throughput efficient 90% of the time. Having the person with the most experience do triage is normally the best use of his time and saves lives.
All of these are based on assumptions that cease to be true in a mass casualty event.
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.
I estimated that they could have gotten at least 4x the throughput (and 4x the utilization of expensive equipment!) if the process was streamlined. For this single patient, at least 45 minutes and probably more was wasted doing what boiled down to nothing of value.
While actually fixing this seems complex, in an emergency situation, 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, even if the person reading the images would personally have lower throughput than if they were in their office.
(Maybe make the 4x into 8x if there could have been two technicians sharing one radiologist.)
The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.
What struck me was how the author was able to identify choke points and make decisions to deviate from procedure to fix them. In many organizations, adherence to procedure is more important than getting good results. It is interesting to see that at least in this hospital at this time, that wasn't true.
Obviously the improvised fixes weren’t planned in advance, but it still speaks to having some process/plan being helpful.
The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.
If the same patients had arrived at a pace consistent with normal operations, wouldn’t you expect the outcomes to have been better?
Normally cross-checking medications and dosages saves lives by reducing medical errors. Normally I’d rather not be operated on by a surgeon so strung out that, like the author describes, his mind can’t make sense of words on a page.
There are times when the problem vastly outmatches the resources you have to bring to bear. Where getting things done at all is more important than making sure they’re done absolutely perfectly. But to me the lesson is in deciding which compromises will save the most lives.
Which has to weigh even heavier on the mind of somebody like the doctor here, who understands that “the very best we could with what we had” is far short of “the best medical care we’re capable of.”
Interesting that he had to do so much thinking and improvising. I'm an EMT in Belgium, and every hospital here has to have plans for mass casualty events. Ambulance bays are built to be transformed into a triage ward, spare beds are kept close, often there's a dedicated command room, ...
There is a rather large difference to having plans and dealing with an actual incident. Not to bicker, but a dedicated command room sounds like a fun plan but the opposite of what was needed in the incident described in this story.
The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.
While that’s true, I worry about glorifying too much the desperation of the whole situation. If the same patients had arrived at a pace consistent with normal operations, wouldn’t you expect the outcomes to have been better? Normally cross-checking medications and dosages saves lives by reducing medical errors. Normally I’d rather not be operated on by a surgeon so strung out that, like the author describes, his mind…
Normally no one wants to be part of a "mass casualty event" but if one ends up in one, I would be glad if competent people do the best they can and not stop on arbitary regulations meant for normal times.
The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.
Some of this can be applied to normal day-to-day running, outside of a crisis.