Archive for category Information

Improving Care and Performance

Discussion of steps you can take to improve performance in your organization. A little from a flute quintet I put together at home. Thanks for listening. JY

I am happy to invite you to the online apparel site. Our goal is for everyone who helps us to save lives to be proud to show people they are part of the UVA Trauma Team.

These are the choices for delivery:

–      If you are a UVA Employee, Resident or Student and willing to pick up your items at a set time and place, choose the “pick up only” option. Bear in mind these will be given out in bulk during a 3-4 hour period at a specified place once a month.

–      For Charlottesville Albemarle Rescue Squad, Charlottesville Fire Department and Albemarle County Fire Rescue volunteer and career personnel, if there are more than 10 orders from your station, I will make one bulk delivery to your station. So, if possible, encourage your people to make their orders in the next 4 weeks. Afterwards, you will need to choose USPS shipping.

–      The other option is USPS Priority Mail Flat Rate Shipping. If you choose this option we will ship your items within 7 days of order unless the item is backordered. A photo of the t-shirt is attached.

If you order embroidery, allow at least 4 weeks for delivery.


Please forward this email to your areas of responsibility and to anyone else you think would be interested in showing they are part of our team.


If you have any questions, please contact us through the site,


Any profit from the sales of these items, above the costs of inventory, packaging, delivery, shipping, taxes, website construction and management, and embroidery will be donated into a gift account that supports trauma research and education at UVA.



Discussion with Ken Lipshy MD on Crisis Management

Ken Lipshy, MD, author of the book “Crisis Management Leadership” discusses the book and the concepts to control performance during a crisis. Thanks for listening. JY


When presenting complex patients, especially as a medical student, you really need to either tape the presentation and listen (which you may not have time for) or run through what you are going to say in your head or out loud to make certain what youre saying makes sense.

For the past few months I’ve heard very good presentation and some very poor ones. The good ones show a bit of thinking on the part of the presenter in the following way: problem-system-status-countermeasure- follow-up

Example of bad: Presenting a elderly patient s/p surgery whose urine output has dropped then presents all the rest of the things that happened in the past 24 hours, then presents all of the organ systems in their entirety, then presents all of the lab data as a monologue and all of the x-ray data and then stops talking and looks up at you.

The problem with this presentation is that you are not synthesizing any of the information, and you’re presenting so much information without emphasis that it is very difficult for anyone who is listening to put together what’s going on patient. In addition, the attending’s mind begins to wander, at least mine does, and the dangerous aspect of that is that they won’t be able to pick up on the cues that may be important in caring for the patient.


Example of good: Mr. Johnson had a total urine output of 240 mL over 24 hours yesterday his weight is down 2 kg, his inputs were 3.5 L and his outputs were 500 mL. His BUN went from 22 to 30 and his creatinine went from 1.6 to 1.8.

As another example: Mrs. Smith got started on five dobutamine her blood pressure at the time was 90/60 her pulse was 95 and she is on beta blockers.  Her lactate was 2.6 and urine output droppped to .3 mL per kilo per hour. Her bicarb was down from 24 to 19 and her BUN had risen from 35-42 and her creatinine from 1.5 to 1.8

You can see from the examples that presenting the event with the context of the data from the system that the event relates to:  1. it proves that you’re thinking, 2. it allows the other people on the team to have a better chance of putting the information together to come up with a viable treatment option and it will also help you learn what data relates to what organ system.


While there may be an attending that will discourage you from presenting this way first of all I think it that’s crazy but second of all even if you have to present in a different fashion you need to use this advice for you to present to yourself or to present others to show that you’re simplified synthesizing the information and putting things together to get a real picture of the patient thanks

Why 10 years of Quality Effort in Medicine Have So Little To Show…

My take on why quality and patient safety improvements in medicine have been so hard to demonstrate, and why. I also present my belief in how we can move more effectively in quality and patient safety if we give up on competition. Also Brian Hughley and I playing “James” by Pat Metheny from a few years ago. Thanks.

FDNY Buff trip

Just got back from a great trip to the Big Apple with my friends from Albemarle County fire. The purpose was to buff FDNY firehouses and units and we saw a ton. The link goes to a video of the pictures I took.  FDNY trip pic video

Couple of thoughts about what goes on in NYC. FDNY is an amazing organization, incredible people, incredible equipment, and incredible training. The “Rock” their training school and simulation center is amazing and their devotion to training is astounding, especially since they think a great deal of themselves, and usually organizations like that rest on their laurels, the FDNY doesn’t do that.

But the disdain for EMS in NYC is really shocking. As many of you know FDNY EMS and FDNY are essentially separate organizations living under the same roof. The FDNY firefighters are trained in CFR (first responder) which is less training than EMT, and yet first respond to all major EMS incidents. What they do their other than comfort and help lift is hard to figure out. And that’s fine, I don’t like many EMS calls myself, but it does actually save lives occasionally, and in order to save the lives you should, you need to have a solid EMS system, which does not seem to exist in NYC. Also, as a former New Yorker, I know how hard it is for us to think anything done outside of NY is worth a sh*t, but I think if you took an unbiased person and had them watch the NYC EMS system in work during a complex call, and then watched the Virginia system in most jurisdictions, I think the differences would be striking.

I don’t know the solution for EMS in NYC but the first step in addressing any problem is realizing you have one.

Time Travel and Recognition Primed Decision Making

A discussion of how experts size up situations and how as an experienced person, you often look ahead in time to predict how your interventions will work. Thanks, JY

Command in the Field

A discussion of being in charge in the station and during incidents with Tom Joyce and Andy Young. Sorry about the backup alarm later in the podcast, that’s what happens when you interview people on duty. Thanks for listening. JY.

Why There’s No Magic in Wizard Systems

A discussion of good and bad systems, and why systems that revolve around “Wizards” don’t grow and improve and eventually become dangerous. Happy New Year! JY

How To Herd Cats: You’ve Got The Job, Now What?

A discussion of how to begin to change your clinical or emergency service. Thanks for listening. JY