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14 Tips to Improve Clinical Efficiency in Emergency Medicine

By Kevin M. Klauer, DO, EJD, FACEP | on July 15, 2015 | 6 Comments
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14 Tips to Improve Clinical Efficiency in Emergency MedicineThe more complex the delivery of emergency medical care becomes, the more critical it is that we find ways to become lean, mean EM machines. Recently, I worked a day shift and was in a comfortable pace, but I noted a steadier volume at 7:30 a.m. than usual. I checked with one of the nurses, making certain the patient in room 10 had received his ice and ibuprofen and was on his way to radiology. She responded, “Why are you in a hurry? We aren’t that busy.” My response was, “How efficient we are now will dictate how we will handle our increased volume later.” We can’t always predict how many patients we will see or how they will be distributed during our shift, but we do have control over what we do with those we already have. From my perspective, there should be two speeds in the ED: off and on. Slipping into slow mode during lulls in volume can be a disastrous strategy. Efficiency results in increased productivity, improved patient safety, happier staff, satisfied patients, and preservation of your sanity.

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ACEP Now: Vol 34 – No 07 – July 2015

Through interactions with others and my own experiences, I’ve compiled the following list of efficiency principles that you may find useful.

1 Identify the decision and work toward it. Every step must bring you closer to your decision point.


2 High volume will drive your efficiency out of necessity, but low volume can tease you into relaxing too much, making you become inefficient.


3 Establish expectations up front with patients and staff.


4 Advise nursing of your plan. Inputting orders into the electronic medical record (EMR) is not good enough. Communicate your intentions. Don’t delegate communication to a computer.


5 Avoid holding pattern tests. These are ordered (often in complex cases) to defer your disposition decision or decisions to order advanced imaging, but they add little to no value to your decision-making process.

  1. Four examples of holding pattern tests:
    • The acute abdominal series (if you need the CT, order the CT)
    • Erythrocyte sedimentation rate and C reactive protein, which are nonspecific inflammatory mediators that rarely change disposition
    • The second troponin when you know the patient needs to be admitted anyway
    • Uric acid (may be high, low, or normal in gout)

Start thin slicing! When busy, use your blink response.1 EPs often know in 30 to 60 seconds what their patients will need. You can take five to six charts, visit each room from the hallway for 60 seconds, and order what is appropriate. Let patients know you will be back to perform your full evaluation, but you want to make sure they are making progress while waiting for you.

Pages: 1 2 3 4 | Single Page

Topics: Emergency DepartmentEmergency MedicineEmergency PhysicianOperationsPractice ManagementPractice TrendsTestingWorkforce

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About the Author

Kevin M. Klauer, DO, EJD, FACEP

Kevin M. Klauer, DO, EJD, FACEP, is Chief Medical Officer–hospital-based services and Chief Risk Officer for TeamHealth as well as the Executive Director of the TeamHealth Patient Safety Organization. He is a clinical assistant professor at the University of Tennessee and Michigan State University College of Osteopathic Medicine. Dr. Klauer served as editor-in-chief for Emergency Physicians Monthly publication for five years and is the co-author of two risk management books: Emergency Medicine Bouncebacks: Medical and Legal and Risk Management and the Emergency Department: Executive Leadership for Protecting Patients and Hospitals. Dr. Klauer also serves on the ACEP Board.

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6 Responses to “14 Tips to Improve Clinical Efficiency in Emergency Medicine”

  1. August 9, 2015

    K Kay Moody Reply

    Awesome, Kevin! Shared with my team

  2. September 13, 2015

    Jean W. Reply

    Thanks! This is so on point. I will be sharing this with my team. A picture (print) is worth a thousand words.

  3. September 22, 2015

    Emergency Physician Speed - How Fast is Fast Enough : Emergency Medicine Cases Reply

    […] Kevin M. “14 Tips to Improve Clinical Efficiency in Emergency Medicine”. ACEPNow 2015 July […]

  4. February 1, 2017

    Xavier Salas Reply

    I think what you said in step number one is the most important. Simply deciding on what to do can be the most difficult step; however, it doubles as the most important step I think. I was unaware that having low volume can make you feel too much at ease, which might not be good for the patient. Thanks for the advice!

  5. February 10, 2017

    Mike Dy Reply

    Hi Kevin,

    Thanks for sharing these tips. very helpful.

    – Mike

  6. January 28, 2019

    Joy Butler Reply

    I think it’s hard to work in health care because with that comes with rash yet calculated decisions. I think that making sure you’re quick to stick with your initial decision is really important. I will have to remember that as I am pursuing a healthcare career.

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