First shift at Urban Blight Memorial. Gotta think of a better name that that, but for now it will do. Busy, but no busier than the hospital I left last spring. First impressions are strongest, so these are my reccommedations (if only I could get paid for consulting on ED design & flow…)

1) Stamped order sheet/t-sheet when chart hits the ledge
2) How about just putting it on a clipboard while you’re at it
3) If you can’t manage the clipboard, lets at least pick the box up off the floor…in fact, I’m going to insist on it for medical reasons…bad back and all.
4) Maybe the fast track extender should umm…see the fast track patients? I know you have to dictate and all, but well, so do we.
5) Working printer for discharge instructions? I had to hand write the last 6 patients I discharged.
6) Residents doing 2 week rotations…either do a full H&P, workup & plan or don’t see the patient at all. OH, and tell me before you leave at the end of your shift, don’t lave me with your messes and unfinished orders/x-rays…
7) When we ditch the t-sheets, do the residents get to dictate a full ED visit and we can just do an addendum? Why are the residents seeing patients anyway? Do they really learn much by doing a history & handing the chart over to the attending?

OK, got that off my mind now. Otherwise, it was fun. I’m working with a medical school classmate which is LOADS OF FUN!!!! This will be a better year. If only I could understand the resident’s english…