As EM physicians, a portion of what we do is very algorithmic and protocolized. It is that way by design so that patients are taken care of in an efficient manner in critical situations, we don’t miss anything and everyone on the team knows their role. For this episode, Drew, Tanner, John, and Andy sit down at ACOEP Spring Seminar 2024 to work through a case and discuss the importance of recognizing when the best thing for the patient may include deviating from protocol.
Why do we use protocols?
We often go by protocol because it helps us not to miss anything and it has typically been studied to show that in general that is the best way to take care of the patient in that scenario. For example, a trauma activation is designed to get the necessary resources mobilized and to the bedside to take care of a patient who may have sustained severe injury. However, we have all had those trauma patients that you do the full work up and they were found to have rather minimal injury. Our job in the ED is to be sensitive and not necessarily specific. Remember that it is always easier to turn off a protocol when it is it recognized that it is no longer needed once more information comes to light than it is to undercall the trauma and then try to activate your resources retroactively.
Can we deviate from protocol?
The short answer is YES! Sometimes deviating from protocol is in the best interest of the patient. Tanner presents a great example in this episode of a case where had the protocol been followed exactly as written, the patient and staff may have been at greater risk for injury based on the patient’s underlying illness. It is important to remember that protocols can be very helpful, but we still need to evaluate each patient individually. Tanner’s case also highlights the importance of listening to our patients.
Once you have decided to deviate from protocol, you have to make sure you communicate this clearly with your staff. They are trained to follow the protocol in these situations and if you don’t explain your thought process, it may be hard to get them on board. They don’t necessarily have to agree with everything you are doing in the moment and there is definitely more time for deep explanation later, but everyone in the room should have a basic understanding of why you are choosing to go a little off-book.
Take-Home Points:
- When considering activating a protocol, it is better to over-call than under-call it.
- Listen to your patients and remember to put the patient first.
- Communicate with the team when you decide to deviate from protocol.
Post by Patricia Capone, DO PGY-3
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