Marilyn McCullum, RN
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Latest articles
Conditions and diseases
Most emergency departments feel perpetually behind. The waiting room fills, ambulances stack, and staff move quickly yet still feel behind. The reflex explanation everyone gives is capacity. We need more beds, more rooms, more space. That explanation is intuitive. It…
Most emergency departments feel perpetually behind. The waiting room fills, ambulances stack, and staff move quickly yet still feel behind. The reflex explanation everyone gives is capacity. We need more beds, more rooms, more space. That explanation is intuitive. It is also often incomplete.
In many departments, nothing meaningful happens after triage until a patient is placed in a permanent treatment room. No bed means no provider evaluation. No provider evaluation …
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The physician-in-triage model and rapid evaluation in emergency medicine
Conditions and diseases
Emergency medicine trains clinicians to recognize patterns early, anticipate deterioration, and intervene before outcomes become irreversible. We pride ourselves on seeing what others miss. Yet we are repeatedly instructed, explicitly or implicitly, to ignore the largest pattern of all. Political…
Emergency medicine trains clinicians to recognize patterns early, anticipate deterioration, and intervene before outcomes become irreversible. We pride ourselves on seeing what others miss. Yet we are repeatedly instructed, explicitly or implicitly, to ignore the largest pattern of all. Political decisions consistently and predictably shape who arrives in our emergency departments, how sick they are, and how unsafe the environment becomes for the people expected to care for them.
If political …
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Alex Pretti’s death: Why politics belongs in emergency medicine
Health policy
The emergency department didn't suddenly get worse. The numbers did. Every shift, emergency clinicians are measured by dashboards that insist on telling a familiar story: Door-to-provider times are too long, length of stay is unacceptable, left-without-being-seen rates are creeping up.…
The emergency department didn’t suddenly get worse.
The numbers did.
Every shift, emergency clinicians are measured by dashboards that insist on telling a familiar story: Door-to-provider times are too long, length of stay is unacceptable, left-without-being-seen rates are creeping up. The implication is clear. We’re slow. We’re inefficient. We’re failing.
But those numbers are no longer describing clinical performance. They’re describing system saturation.
Emergency departments today operate in conditions that were once considered temporary …
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Emergency department metrics vs. reality: Why the numbers lie
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