Basic decisions in Emergency Department cases: a logical approach

In the emergency department teaching program at Brooke Army Medical Center, housestaff rotating through the emergency department are given an algorithm for use in making basic diagnostic decisions. Housestaff frequently believe that the result of their contact with a patient should be establishment of the correct pathophysiological etiology of the patient's chief complaint followed by definitive therapy and feel anything less is unacceptable. The algorithm, which had been in use for nine months at the time of this report, was formulated in an attempt to deal with the problems such views may create, such as inappropriate management of patients who obviously require admission, second-best care, and delays for patients requiring emergency department evaluation. The algorithm has been successful in changing housestaff attitudes and actions and will continue to be used.