I have practised emergency medicine for 41 years. For the past 31 years I worked full time, exclusively doing 12-hour night shifts at Dartmouth General Hospital in Nova Scotia. I am 70 years old, soon to be 71 years old. My unrestricted licence to practise medicine in Nova Scotia came into effect 9 hours after I graduated in 1967.
My goal has always been “zero”—that is, to have zero new patients waiting in the emergency department (ED) at least once during my 12-hour night shift. I am almost always successful in reaching this goal, and for the past 3 months I have always reached it.
Having zero patients, even if it happens momentarily, is a great morale booster for all ED staff. They can then concentrate on the patients already in the ED and see new patients in a timely fashion. If all the staff on a shift have zero patients as their goal (as well as good care, of course), it happens—at least that’s been my experience, no matter how bad things look at the start of a shift. Getting to zero patients is becoming more challenging as time goes by, because the patients are sicker and the “quickies” are now a very small minority of the ED patient population.
I think that zero patients is a good 24/7 goal for all ED staff to have. In the daytime, practising zero might at least decrease the wait time, and perhaps prevent the night staff from starting “behind the eight ball.”
To practise zero, there has to be less gabbing, and staff should not bring their new house plans to the ED to get everyone’s opinion. (I’ve seen it happen.) If there is a congregation of staff having a “gab fest” when there is much work to be done, simply walk by and say “I’m glad we had this little talk.” It works every time—the congregation quickly disbands.
Just a few “zero” thoughts.
Footnotes
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Competing interests
None declared
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