How To Deal With Three Critically Ill Patients At The Same Time

Everybody has had these shifts: in the ER, the ICU or on the ward: the phone won’t stop ringing, several red alarms at the same time and everybody calls your name and is mad, that you won’t show up.

Here is my eleven-step-strategy to stay on top of things – even when times get rough.

1. Make A List (on paper! You can’t remember more than 3 things) of things that have to be dealt with.
2. Acknowledge: You can Only do one thing at a time. Multitasking is a myth, and nobody can do two things at the same time.
3. Decide: Who is the sickest person here right now and needs your attention right now? How can this guy be helped? Many times it is possible to enter the patient’s room, analyze the situation quickly and give the nurse orders to stabilize the patient:
   • start catecholamines,
   • increase FiO2,
   • call for a consult if needed
   • call the ICU so he can be referred.

     Just get things moving in the right direction.

4. Brief the  nurse and give her the following orders:
   1. Tell her that you are aware of the fact that this patient is very critical.
   2. Inform her that several other critical patients need your attention right now and also need your attention.
   3. Tell her to have a close eye on him.
   4. Tell her to report on you immediately when the status of the patient deteriorates.
5. Decide again: who is second in line? Go back to step 4.
6. Delegate: Focus on the things that can only be taken care of by you. Everything else has to be delegated or postponed. If exams have to be scheduled or tests have to be ordered, ask a nurse for help.
7. Postpone any task that is not urgent.
   This may include things that are very important! Like talking to relatives of a (stabile patient), documentation, or even taking a break. Be aware that these things are important, but since they are not urgent right now they will have to be dealt with later.
8. DON’T WASTE TIME.
   Some of my beloved colleagues spend a lot of time complaining about these situations. Don’t!It only costs time since no hospital manager is around to hire more people or give you a raise. Just don’t complain!

   If you don’t like your job: quit.

   Complaining costs time and demotivates everybody around you! Another way to waste valuable time are unimportant phone calls. Without being impolite tell the caller that you are in an emergency situation and ask whether his issue has some time…

9. Get help:
   • ask colleagues to stay a little longer
   • call in your On-Call-Doctor
   • ask colleagues on different wards for help.

     Asking for help is no sign of weakness but helps shows that you have.

10. Don’t be rude.
    There is a high risk of being rude when you are overwhelmed, at least I’m at risk for this kind of behavior. There is a possibility that nurses or other patients won’t understand why you won’t focus on them.Explain them briefly in 2-3 sentences that you cannot deal with their problem right now, because there are people, who are dying if you don’t focus on them.

    Most of them will understand. If not, oh well…can’t help them.

11. Keep a positive attitude: 
    Be honest: it is that adrenaline rush why you went into medicine, isn’t it? In my opinion, these action-days are one of the reasons why we love our job!Busy days are full of great opportunities to save lives, to be of help to other people. That’s what we are here for…