Blog 24 - Last Presentation Reflection

1. Positive Statement
1. What are you most proud of in your block presentation and/or your senior project? Why?
1. I am really proud of how I carried myself. My voice typically shakes a lot and I tense up and stand in the corner. I surprisingly wasn't insanely nervous once I actually got started.
2. Questions to Consider
1. What assessment would you give yourself on your block presentation?  Use the component contract to defend that assessment.
1. AE 
2. I think my activities explained my answers exceptionally well. I improved a lot from my prior presentations with my use of the powerpoint and way I spoke. 
2. What assessment would you give yourself on your overall senior project? Use the component contract to defend that assessment.
1. AE  
2. I feel like I really worked hard this year and took the project seriously. Nearly all my sources were medical journals. My independent components totaled well over 100 hours and was actually something that will be helpful later on. I logged a total of 210 hours. My interviews, although not in person, were with major researchers(published 5+ medical journal articles on the topic) in the field of overcrowding. 
3. What worked for you in your senior project?
1. I kept on top of my deadlines. I tried to get mentorship hours out of the way early on which was helpful because once my EMT class started it made it nearly impossible to go. 
4. (What didn't work) If you had a time machine, what would you have done differently to improve your senior project?
1. I wish I had done more interviews. They seemed like a pain in the beginning, but they actually became some of my best sources. 
5. Finding Value
1. How has the senior project been helpful to you in your future endeavors?   Be specific and use examples.
1. It pushed me to go out and make contact with experts in this field. I really improved my interview skills and presentation skills. Probably the most valuable, though, was being pushed to get my EMT certification. It wasn't something I could ever see myself doing on my own, but I am so glad I did it now. It is something that I will actually be able to do during college.  

Exit Interview

1. What is your essential question, and what are your answers?  What is your best answer and why?
1. What is the best way to minimize Emergency Department overcrowding?
2. Nurse hotlines, improved access to primary care, inpatient hallway boarding
3. My best answer is inpatient hallway boarding. It is very easy to implement and directly attacks the major cause of overcrowding: boarded patients. Both my interviews 3 and 4 cited this as one big way to fix overcrowding. Unlike my other answers, it does not take care away from those who use the ED as a source of primary care. 
2. What process did you take to arrive at this answer?
1. I originally found this answer from my third interviewee when he talked about moving patients up without an actual bed for them. I found a little bit of research about it then. I found quite a bit more when my fourth interviewee recommended that I look up the founder of the system for moving patients to inpatient hallways. I found quite a bit of research on the actual system, its success rates, and nurse views on the system. 
3. What problems did you face?  How did you resolve them?
1. I think my biggest problem is getting other people to care about something that's so administrative. It isn't bloody and gory like most people think my topic would be. I also had a hard time finding time for mentorship. My mentor typically works nights which would be almost impossible for me to do during the week. I usually went in on Fridays or during the weekend. Once my EMT class started, though, I was unable to go to mentorship at all. Luckily I still got all the required hours done. 
2. Another problem I faced was getting interviews. People in Emergency Medicine are typically very busy with very abnormal schedules. Unfortunately, I was only able to do one interview in person. I wish they all could have been because I did feel like I got better information that way, but my interviews were still extremely helpful. 
4. What are the two most significant sources you used to answer your essential question and why?
1. If I had to choose, I think my two most valuable were my last two interviews. They really set me on the path for my last two answers. They both recommended certain sources which assisted in my research. If I didn't have these interviews my answers would have been totally different. 
2. I don't feel like those two interviews were what really made or broke my project, though. I found that people, such as Dr. Richards, Dr. Viccellio, Dr. Pines, and Dr. Derlet, were really my best sources. They all published great articles that really helped me understand overcrowding and then figure out my answers. If I never found them my project wouldn't have a leg to stand on. 

Blog 22 - Independent Component 2

• Literal
• I, Lauren Burney, affirm that I completed my independent component which represents 86 hours of work. 
• I used the textbooks Emergency Care and Transportation of the Sick and Injured and UCLA Center for Prehospital Care Supplement. My lectures for the course are Quinn Bowyer and Jeff Pollakoff. The skills instructors vary. 
• Link
• The last half of my EMT class moved significantly faster than the first. I learned so much about the nitty-gritty of the human body, medical conditions, and how I can treat them. I refined my CPR skills and will hopefully improve on my patient assessments. I learned some great skills like splinting, setting up an IV bag and intubation tubes, and delivering a baby. During the class, I managed to kill myself only once and my patients a few times. 
• Interpretive
• I have spent far over 30 hours in class and many more hours studying and completing the required homework. This project is preparing me to actually become a provider of emergency medicine. Before I am given the certificate of completion, I will actually spend at least 24 hours on an ambulance providing care to at least 10 patients. 
• Applied



This category comprised 70% of my final grade. The final exam alone was 30% and took almost two hours to complete. Over half the class didn't have the minimum grade in order to even take the final. 

• This class has helped me understand what these people who work in this field actually go through. My instructors have told the class stories about their triumphs and tribulations which have given me a better understanding of the system in general. Also, learning how to be an actual provider on an ambulance has given me a better understanding of how ambulance diversion can affect patient care. As far as answering my EQ, this class allowed me to understand how some of my answers can work in real life. 

Blog 21 - Interview 4 Reflection

1. What is the most important thing I learned from the interview?  
1. The most interesting thing learned that although people co-publish medical articles, they can still have differing views. My interviewee 4 co-published several articles with my interviewee 3. To spot any differences in their answers, I asked them similar questions. I was really surprised when they answered oppositely on several things foundational to my topic. I asked my interviewee how he would rank my three answers, which will definitely help me to pick my best one. 
2. How will what I learned affect my final lesson?
1. His answers will help me to be more confident in what I have found throughout the year. It will also help me be confident in what I chose as my best answer because my third interviewee did not agree with me. 

*This interview was conducted through email.

Blog 20 - Interview Four Prep

What my interviewee probably looks like on the other end of the line.

1. Who do you plan to interview?  What is this person's area of expertise?
1. I am going to interview Dr. Jesse Pines. He is an Emergency Medical Physician at George Washington University Medical School.
2. Post 20 open-ended questions you want to ask an expert in the field concerning your senior project. Your focus should be finding answers to your EQ.
1. What first interested you in the topic of overcrowding?
2. What do you believe are the greatest factors causing overcrowding?
3. Which do you believe plays a bigger role, patient misuse of the ED or hospital crowding?
4. Who or what do you believe has the most influence over hospital policies regarding overcrowding?
5. What do you think will have to change in order for this problem to improve?
6. How do you feel about legislation to enforce solutions to this problem? Do think it may need to get to this point?
1. If so, what kind of legislation?
2. Do you think that having the 4-hour rule compromises safety too much?
7. Do you think that mandating health insurance will affect ED visits?
8. Should access to urgent care also be lumped with primary care access?
9. Are there any plans you have put into action to improve overcrowding where you work?
1. Yes: What were they? How easily were they adopted? What effects did they have?
2. No: Why not?
10. If you had to pick just one answer to the question, “What is the best way to minimize Emergency Department overcrowding?”, what would it be?
11. How would you rank the options: gatekeeping/nurse hotlines, improving primary care access, and inpatient hallway boarding?
12. Do you think there is a problem with referring people to lower levels of care(UC, PC) after triaging?
1. Is it correct to assume that anything could be an "emergency medical condition" because of EMTALA?
13. Explain what UCR medical school is doing for several students… How effective do you think this would be?
14. Are there any other significant issues facing emergency departments nationwide?
15. What do you think the Emergency Department will look like in terms of patient volume, providing locations, and overcrowding in 5 years? 10 years?
16. Do you have any articles or journals you suggest I check out?
17. Any last pieces of advice for someone looking to go to medical school down the road?

Blog 19 - Third Answer

Stony brook Hospital
This hospital pioneered the idea of inpatient hallway boarding.

1. EQ
1. What is the best way to minimize Emergency Department overcrowding?
2. Answer #3 (Write in a complete sentence like a thesis statement)*
1. The best way to minimize Emergency Department overcrowding is through the use of inpatient hallway boarding. 
3. 3 details to support the answer 
1. Inpatient hallway boarding allows the hospital to distribute the stress of overcrowding so one department(the ED) doesn't suffer as much. 
2. This is only used for stable patients, so it is safe. 
3. Some hospitals have already implemented this solution and it has had favorable results. 
4. Several studies show that 50% of patients would prefer to board in an inpatient hallway. 
4. The research source(s) to support your details and answer
1. Interview 3
2. Sources 38, 44, 45, 47, 54 
5. Concluding Sentence
1. This is a good answer for my EQ because it doesn't require a lot of extra money or resources. The process of boarding patients in inpatient hallways has been proven to speed up the rate of bed turnover. Patients who are in inpatient hallways have many of the same amenities as those in normal inpatient rooms. 

Blog 18 - Answer 2

1. What is your EQ?
1. What is the best way to minimize Emergency Department overcrowding?
2. What is your first answer? (In complete thesis statement format)
1. The best way to minimize Emergency Department overcrowding is through the use of nurse hotlines.
3. What is your second answer? (In complete thesis statement format)
1. The best way to minimize Emergency Department overcrowding is to improve patients' access to primary care. 
4. List three reasons your answer is true with a real-world application for each.
1. One of the biggest reasons people come to the ED is because they cannot make an appointment with their primary care physician. By improving access to these physicians, ED visits should be reduced. 
2. This affects the demand portion of the supply and demand issue which causes overcrowding.
3. This is a valid answer because of the input-output-throughput model which demonstrates how patients flow through the hospital and the ED. 
5. What printed source best supports your answer?
1. Piehl, Mark D., Conrad J. Clemens, and Jerry D. Joines. ""Narrowing the Gap"" Arch Pediatr Adolesc Med Archives of Pediatrics & Adolescent Medicine 154.8 (2000): 791. Web. 10 Feb. 2016. <http://archpedi.jamanetwork.com/article.aspx?articleid=350544>.
6. What other source supports your answer?
1. During my third interview I asked my interviewee what he thought the answer to my essential question was and he strongly believed in my second answer. 
7. Tie this together with a concluding thought.
1. This second answer is similar to the first in that it affects the input of the hospital/ED. Input is basically how many people show up wanting treatment. By improving the availability of primary care, the number of non-urgent visits will be reduced because patients can treat it with their normal doctor. By seeing a primary care physician instead of a doctor in the ED, patients can save money, have better follow up care, and develop a stronger relationship with their doctor. 

Blog 17 - Interview 3 Reflection

1. What is the most important thing I learned from the interview?  
1. I learned a lot from this interview, probably the most out of all my interviews thus far. I think the most important thing I learned was that my interviewee believes that making primary care more available would be the most important step in reducing Emergency Department overcrowding. I also learned about a method of minimizing the effects of crowding which could be an answer. 
2. How has your approach to interviewing changed over the course of your senior project?
1. I believe I am a little more comfortable now than I was when I did my very first interview. My questions for this interview definitely connected more and actually flowed well into each other. What I think worked for this interview is that I didn't use my questions in the exact order that I had written them. I knew most of them by memory so when a topic I had written a question about came up I knew to jump to it instead of going down the list like a checklist. 
3. Link to interview transcription
 

Blog 16 - Independent Component 2 Approval

1. Describe in detail what you plan to do for your 30 hours.
1. I plan to continue taking my EMT class. The class on Saturday and Sunday from 8-5 for eight weekends. It is a huge undertaking, much bigger than I first anticipated. I am currently half way through the class. When I turn 18(in April, several weeks after the class ends) I will complete two 12 hours ride alongs in an ambulance to finish my class. After, I will take the NREMT, the national certification exam. 
2. Discuss how or what you will do to meet the expectation of showing 30 hours of evidence.
1. I will have a transcript by the time IC2 is due. In order to complete the class and get my certificate of completion, I have to spend at least 120 hours in skills and lectures. I should also have some pictures from my ride alongs.
3. Explain how this component will help you explore your topic in more depth.
1. This will help me because it's literally teaching me how to become a provider of emergency care. Also, depending on where I do my ride-along, I will be able to see some other overcrowded hospitals and possibly diversion.
4. Post a log in your Senior Project Hours link and label it "Independent Component 2" log.
1. Link

Lesson 2 Reflection

1. What are you most proud of in your Lesson 2 Presentation and why?
1. I am most proud that I was able to keep my cool. Unlike the last lesson where I was super stiff and could barely choke the words out, I felt like I was more fluid. I am also happy that all my practice at making time paid off. 
2. What assessment would you give yourself on your Lesson 2 Presentation (self-assessment)?
1. P
2. Explain why you deserve that grade using evidence from the Lesson 2 component contract.
1. I feel like I hit all the points on the contract. I felt like my activity went very well with my first answer once I explained how it related. I think my use of statistics showed the depth of my knowledge. 
3. What worked for you in your Lesson 2?
1. Having a powerpoint was a total relief because I feel like I wouldn't be able to remember all the information I presented. I think that I also used my time effectively. 
4. What didn't work? If you had a time machine, what would you have done differently to improve your Lesson 2?
1. I think I would have tried to reference my independent component. I actually had an extra slide after my "thank you" slide that talked more about mentorship and my IC in case I needed more time. Once I got to my conclusion side, though, I was right at 21 minutes so I just cut it out.
5. What do you think your answer #2 is going to be?
1. I think it will either be hospital restructuring or patient education. This will really depend on how my third interview goes, though. 

Blog 15 - Independent Component 1

• Literal
• I, Lauren Burney, affirm that I completed my independent component which represents 59 hours of work. 
• I used the textbooks Emergency Care and Transportation of the Sick and Injured and UCLA Center for Prehospital Care Supplement. My lectures for the course are Quinn Bowyer and Jeff Pollakoff. The skills instructors vary. 
• Link
• In order to even take my EMT class, I first had to take a CPR for Healthcare Providers class. This took up several hours, but I am now CPR certified. So far I am three weeks into my eight week EMT class. I have learned some basic anatomy, ethical and legal obligations of being an EMT, airway, and ventilation interventions, assessing patients, and taking vitals. After being lectured at for four hours, we spend another four hours actually practicing the skills we learned about. So far I have learned how to maintain an open airway, basic lifting techniques, administer oxygen, perform CPR, take a manual blood pressure, and assess patients. 
• Interpretive
• I have spent far over 30 hours in class and many more hours studying and completing the required homework. This project is preparing me to actually become a provider of emergency medicine. Before I am given the certificate of completion, I will actually spend at least 24 hours on an ambulance providing care to at least 10 patients. 
• Applied
• This class has helped me understand what these people who work in this field actually go through. My instructors have told the class stories about their triumphs and tribulations which have given me a better understanding of the system in general. Also, learning how to be an actual provider on an ambulance has given me a better understanding of how ambulance diversion can affect patient care.  

This is a screenshot of my posted grade. While there are other things in the grade book, it is too much to post everything. The exams portion comprises 40%(the largest portion) of my final grade.

Blog 14 - Third Interview Preparation

What is the best way to minimize Emergency Department overcrowding?

1. Who do you plan to interview?  What is this person's area of expertise?
1. I plan to interview my mentor's boss, the director of the ED. He has a similar experience as my mentor and has probably more of a hand in the structuring of the department. I have contacted my mentor to get in touch with his boss, but he hasn't gotten back to me yet.
2. Verify that you have called your interviewee to schedule an interview.  What is the date and time of the interview? 
1. I haven't scheduled one yet.
3. Phrase an open-ended question that will help you find research resources that would help to answer the EQ.
1. Do you, or anyone you know, subscribe to any journals that deal with hospital/emergency department management?
4. Phrase an open-ended question that will help you think about other useful activities you might do to help you answer the EQ (IC2, possible experts to talk to, etc).
1. Who do you believe has the most influence over hospital policies about overcrowding?
5. Phrase two open-ended questions that help you to understand your interviewee's perspective on an aspect of your EQ.
1. How do you think overcrowding has affected this department?
2. What do you think is the biggest issue facing emergency departments state/nationwide?

The interview transcript  is due to turnitin.com with the 5-minute audio excerpt and entry to the blog on Friday, February 19th. In addition, you need to turn in the verification sheet to your house teacher

Blog 13 - 10 Hour Mentorship Check-In

1. Where are you doing your mentorship?
1. Downey PIH(formerly Downey Regional Medical Center) Emergency Room
2. Who is your contact?  What makes this person an expert?
1. Dr. Miguel Rodriguez
2. He has over 20 years of experience as an emergency room physician. He graduated from Stanford Medical School with a specialty in Emergency Medicine.
3. How many hours have you done during the school year? (Summer Mentorship Hours and Mentorship Hours should be reflected separately in your Senior Project Hours log located on the right-hand side of your blog).
1. 51 hours
4. Succinctly summarize what you did, how well you and your mentor worked together, and how you plan to complete the remaining hours.
1. During mentorship, I basically follow my mentor as a "shadow". Since my mentor is typically pretty busy filling out patient charts, giving orders, or consulting with other physicians, he doesn't usually have a whole lot of time to explain little details about why he is doing certain treatments. I can almost always figure out what is going on, though, and if I can't then I take a note of it and look it up later. I have finished the mandatory hours, but I plan to continue doing what I have been doing whenever I get the chance.