Lessons learned from a bouffant surgical cap.

Abstract

As a medical student rotating through the emergency department, I would often don a bouffant surgical cap before stepping into the trauma bay to observe as a patient was rolled into the room. How strange those caps made of polypropylene seemed to me: the individual fibers so thin and woven in a pattern that seemed like disarray. How could a thing so flimsy be helpful to our patients? On my first day of the rotation, the emergency department itself seemed like a reflection of those caps: the clatter of portable x-ray and EKG machines wheeled around the hallways, the clamor of consultants hurrying in and out of rooms, the patients clustered in the waiting room and crowded into hallway beds as providers rushed to see the next patient needing the most acute care. But as I observed the emergency department during the month of that rotation, the seemingly random jumble of patients mixed with providers settled into place. In just one afternoon: a nurse charged into a patient room to alert a doctor about another patient close to crashing in the room next door. Several consultants gathered at the nurse’s station so the charge nurse could join them to coordinate a plan for a patient in their shared care. The x-ray technician wheeled over the machine to the doctors’ row of computers to point out a concerning finding on the screen so that the problem can be quickly addressed. Respiratory technicians adjusted ventilator settings and then communicated changes in patients’ status to the physicians moving between patient rooms, giving updates on those patients who needed attention most urgently to help busy physicians with triage. A paramedic waved at a nurse for her attention to prioritize grabbing medications for a patient whose blood pressure needed more than just the bag of fluids that was infusing. The intensity and pace of the emergency department makes it appear like commotion. By the nature of emergency situations where the first goals are making certain patients are breathing and keeping their hearts beating, some disarray can be expected. But then watch an interprofessional team perform the primary and secondary survey of a trauma—such a synchrony of motion between physicians, anesthesiologists, surgeons, nurses, and radiographers that professional performers would stare in awe—and realize there is far more organization than may at first appear, and that collaboration is at the true center of the emergency department. Now, as a hospitalist who cares for admitted patients, I appreciate that, while the process in the emergency department is different from the step-by-step organization of inpatient medicine, with its routine of formal rounds, then placing consults, then getting orders entered, the nature of the emergency department calls for these things to happen at the same time. It is all these things happening together, guided by the hands of emergency department providers skilled at coordinating each simultaneous piece of care, that makes certain our patients seeking emergency help are well cared for. Like a polypropylene bouffant cap, at first glance the emergency department may seem like a place where the individual fibers comprising it are flimsy and woven together at random. But try to pull apart a bouffant cap and realize that the fibers do not tear so easily. The threads of the emergency department staff are like the fabric of those caps; each thread essential but also relying on connections between one another to be strong as a whole. It is this strength of multidisciplinary teamwork among providers all striving toward the goal of achieving positive health outcomes that facilitates the best possible patient care.