Prioritization, Delegation and Staff Management
1. Prioritization
Prioritize—you are deciding which pt is sickest or healthiest… Make sure you know what
you’re looking for
Question
For instance, if the question states that there was a disaster in town and you are making
room for the wounded, who would you discharge?
• In that case, would you be looking for the highest or lowest priority pt?
• Answer: the lowest priority pt
Question
However, if the question states that you receive handoff end-of-shift reports on 4 pts.
Which pt will you check first?
• Answer: the highest priority pt
Answers will usually have 4 parts
• (1) Age, (2) Gender, (3) Dx, and (4) a modifying phrase
• For example: A 10-year-old male with hypospadias is throwing up bile-stained emesis
Age: 10-year-old
Gender: male
Diagnosis (Dx): hypospadias
Modifying phrase: throwing up bile-stained emesis
2 of which are irrelevant for answering the question
Age and gender are not important in prioritization
Age is important in pediatrics
Of all 4 parts, the modifying phrase is more important
Remember
The modifying phrase is always the most important
Example
Two pts: one has angina pectoris and the other myocardial infarction. Who has the higher
priority pt?
Answer: The MI pt
Go by the patient’s condition since there is no modifying phrase
, Example
Now modifying phrases are added to each of the diagnosis, which pt becomes the higher
priority?
a. Pt with unstable BP and Angina
b. Pt with stable vital sigh and MI
Answer: Pt with angina and unstable BP becomes the priority pt
4 rules for prioritization
1. Acute beats Chronic
Meaning that an Acutely ill pt has higher priority than chronically ill pts
For instance, among the following pts, a pt with COPD, CHF, or appendicitis, which one
has the highest priority?
o Pt with appendicitis (acute condition). Both COPD and CHF are chronic conditions
2. Fresh post-op (12 hours) beats medical or other surgical
For instance, among the following pts, a pt 2-hour post cholecystectomy, a pt with COPD,
and a pt with acute appendicitis, which pt has the highest priority?
The 2-hour post cholecystectomy is the highest priority pt … (Fresh post-op, <12 hours)
Pt with “radical neck dissection” is added to the above scenario?
The 2-hour post cholecystectomy is the highest priority pt
Pt with “bilateral above the knee amputation” is added to the above scenario?
The 2-hour post cholecystectomy is the highest priority pt
Pt with “right frontal craniotomy” is added to the above scenario?
The 2-hour post cholecystectomy is the highest priority pt
The point here is that surgery less than 12 hours takes precedence over medical and other
surgical conditions
3. Unstable beats Stable
This means that an Unstable pt has a higher priority over Stable pts
How to determine that a pt is stable or unstable?
Word description that makes a pt stable • Stable • Unstable
• Chronic illness • Post-op greater than 12 hours • Local or regional anesthesia • Lab
abnormalities in the A or B level, Creatinine, BUN, Hemoglobin 8 to 11, Bicarb, elevated
Hematocrit, elevated BNP, elevated Na level, RBCs off Word description that makes a pt
unstable
1. Prioritization
Prioritize—you are deciding which pt is sickest or healthiest… Make sure you know what
you’re looking for
Question
For instance, if the question states that there was a disaster in town and you are making
room for the wounded, who would you discharge?
• In that case, would you be looking for the highest or lowest priority pt?
• Answer: the lowest priority pt
Question
However, if the question states that you receive handoff end-of-shift reports on 4 pts.
Which pt will you check first?
• Answer: the highest priority pt
Answers will usually have 4 parts
• (1) Age, (2) Gender, (3) Dx, and (4) a modifying phrase
• For example: A 10-year-old male with hypospadias is throwing up bile-stained emesis
Age: 10-year-old
Gender: male
Diagnosis (Dx): hypospadias
Modifying phrase: throwing up bile-stained emesis
2 of which are irrelevant for answering the question
Age and gender are not important in prioritization
Age is important in pediatrics
Of all 4 parts, the modifying phrase is more important
Remember
The modifying phrase is always the most important
Example
Two pts: one has angina pectoris and the other myocardial infarction. Who has the higher
priority pt?
Answer: The MI pt
Go by the patient’s condition since there is no modifying phrase
, Example
Now modifying phrases are added to each of the diagnosis, which pt becomes the higher
priority?
a. Pt with unstable BP and Angina
b. Pt with stable vital sigh and MI
Answer: Pt with angina and unstable BP becomes the priority pt
4 rules for prioritization
1. Acute beats Chronic
Meaning that an Acutely ill pt has higher priority than chronically ill pts
For instance, among the following pts, a pt with COPD, CHF, or appendicitis, which one
has the highest priority?
o Pt with appendicitis (acute condition). Both COPD and CHF are chronic conditions
2. Fresh post-op (12 hours) beats medical or other surgical
For instance, among the following pts, a pt 2-hour post cholecystectomy, a pt with COPD,
and a pt with acute appendicitis, which pt has the highest priority?
The 2-hour post cholecystectomy is the highest priority pt … (Fresh post-op, <12 hours)
Pt with “radical neck dissection” is added to the above scenario?
The 2-hour post cholecystectomy is the highest priority pt
Pt with “bilateral above the knee amputation” is added to the above scenario?
The 2-hour post cholecystectomy is the highest priority pt
Pt with “right frontal craniotomy” is added to the above scenario?
The 2-hour post cholecystectomy is the highest priority pt
The point here is that surgery less than 12 hours takes precedence over medical and other
surgical conditions
3. Unstable beats Stable
This means that an Unstable pt has a higher priority over Stable pts
How to determine that a pt is stable or unstable?
Word description that makes a pt stable • Stable • Unstable
• Chronic illness • Post-op greater than 12 hours • Local or regional anesthesia • Lab
abnormalities in the A or B level, Creatinine, BUN, Hemoglobin 8 to 11, Bicarb, elevated
Hematocrit, elevated BNP, elevated Na level, RBCs off Word description that makes a pt
unstable
