Acuity-based time allocation

Acuity Levels - Sorting the Sick

• Triage Goal: Prioritize care based on clinical urgency to optimize outcomes.
• Core Method: Use a standardized system (e.g., ESI, START) to categorize patients.

• Level 1 (Red): Critical. Immediate, life-threatening condition (e.g., cardiac arrest, major trauma, shock). Requires intervention NOW.
• Level 2 (Yellow): Emergent. High-risk situation, potential for deterioration (e.g., severe asthma, chest pain, long bone fracture). Treat within minutes to hours.
• Level 3 (Green): Urgent/Non-urgent. Stable, minor illness or injury (e.g., simple laceration, URI). Can wait.

⭐ High-Yield: In mass casualty incidents (MCI), patients who are apneic despite airway repositioning are often triaged as Black (Expectant/Deceased) to redirect resources to salvageable patients.

Clock Strategy - Racing the Clock

• Core Principle: Mentally assign fixed time blocks to each phase of the case (e.g., initial assessment, workup, management) to maintain momentum and avoid getting stuck.
• Pacing is Acuity-Dependent: Your internal clock must adapt to the patient's stability.

• The "Two-Minute Warning": Always reserve the final 2 minutes to review all orders, check for pending results, and provide crucial discharge/admission counseling.

⭐ In unstable patients, the 'order-set' for immediate stabilization (IV access, O2, monitor, key labs/meds) should be placed within the first 2-3 minutes. Delaying this for a detailed history is a critical error.

High-Acuity Cases - Code Red Protocol

• Principle: Immediate, simultaneous assessment & intervention for life/limb-threatening emergencies. The goal is stabilization within the "Platinum 10 Minutes" of patient contact, preceding the "Golden Hour".
• The 2-Minute Drill: Your first 120 seconds are crucial and dictate immediate outcomes.
  • Assess: Rapid primary survey (ABCDE). Is the patient actively dying? (e.g., gasping, major hemorrhage).
  • Act: Initiate critical interventions as you identify problems. Do not delay for detailed history or diagnostics.
    • e.g., Secure airway, needle thoracostomy, start two large-bore IV lines, control external bleeding.
  • Alert: Activate institutional "Code Red" / Trauma Team immediately. Never manage a crashing patient alone.

⭐ Exam Pearl: In trauma, the "Golden Hour" is critical, but the on-scene time for providers should be limited to the "Platinum 10 Minutes" before initiating transport to a trauma center.

• 📌 Mnemonic (ACT): Assess & Alert, Critical Interventions, Transport.

Low-Acuity & Dynamic Cases - Steady Does It

• Pacing is Key: Avoid rushing. Use a steady, methodical approach for stable patients. This prevents errors and ensures a complete workup.
• Sequential Orders: Order tests, then advance the clock to see results. Don't order everything at once; it reveals your plan.
• Periodic Re-evaluation: Dynamic cases evolve. After initial orders, re-check vitals and patient status to guide your next steps.

⭐ Use the 'Advance Clock' feature wisely. Finishing stable cases efficiently builds a crucial time buffer for more critical encounters.

High-Yield Points - ⚡ Biggest Takeaways

• Always prioritize the sickest patient; this is the cornerstone of effective CCS time management.
• Use the ABCDE approach to rapidly assess acuity and identify immediate life-threatening conditions.
• Allocate the majority of initial time to unstable patients requiring urgent, life-saving interventions.
• Periodically re-evaluate stable patients, as their clinical status can deteriorate unexpectedly.
• Critical actions precede documentation. Stabilize the patient before extensive charting or order entry.
• Advance the clock strategically after key interventions to simulate real-time patient responses.