5 Great Time-Saving Tools

By:  DMKashmer MD MBA MBB FACS (visit me on LinkedIn here.)

 

Have you ever looked at what you do everyday?  No, no–I mean really looked at it.  Not just the “here’s-what-I’m-doing-today” type of review.  I mean a data-driven, how-do-I-spend-my-time review.

 

It takes effort, and some focus, to keep a time journal or use some similar tool.  For me, it took more than a month to get something down on paper that was useful and really showed me how I use my time.

 

That month lead me to find several useful tools that help me use time not just more efficiently but more effectively.  Today, I want to share with you some of the most useful tools and tips that I hunted down in response to my month spent in review of how I squandered, wasted, or otherwise just plain mis-used my time.  Please learn from my hunt so you don’t need to find these yourself!

 

(1) Dropbox

Have you ever needed a password for a website that you haven’t used in awhile?  What about a birthday, login, or that article you read a year ago and really want to share right now?

You’ve probably heard of the cloud storage service Dropbox.  Yes, it has a great name, because it tells you exactly what it does.  On Mac, PC, iPhone, and other devices, you can easily upload and access your files right when you need them.

This allows you to setup some interesting workflows.  For example, did you know that you can share a dropbox folder with someone else?  So, imagine dictating something into your iPhone and uploading it to Dropbox where your colleague accesses it and transcribes it only to send it to you as an email later that day.

Dropbox is a great app to make data accessible across platforms, available in a timely fashion, and positioned to be useful to colleagues who help you out!

As with other useful apps that may contain data you don’t want shared, remember to enable two-step verification and other security measures whenever possible.  Otherwise, you may have an issue if your laptop ever gets stolen with Dropbox enabled…it happened to me just last year!

 

 

(2) Evernote

Yes, you can use Dropbox to create shared Word documents.  However, no application has the ease of use to create searchable, shared, multimedia notes like Evernote.  Your phone and computer can be a portal to notes shared among all the colleagues with whom you work.

Evernote has several great features, and one is that you can email anything directly to your account in the program.  Interestingly, you can even setup a folder to receive all of that data you send to Evernote.  You can then sort it later at your convenience.

These thoughts don’t even touch many of the great uses for this powerful platform.  If you decide that you ever want to really have a look in on Evernote, take a moment and read SJ Scott’s Master Evernote available on the Kindle platform.

As with Dropbox, allow me to recommend that you setup two-step verification.

 

 

(3) 1dollarscan.com

Ok, now things get more interesting.  Have you heard of 1dollarscan.com?  Maybe not…I found this one when it came over from Japan.  I wondered why, nowadays, I always had to carry around a book I wanted to read.  I mean sure, there are Kindle books (and Nook too), yet I mean those platforms restricted my ability to share my books with anyone or to give them to others to read…just like I would with my books.

I thought there had to be a better way to have my books available, in a less restricted way, when I wanted them.  From a time management perspective, 1dollarscan has been incredibly useful.  For example, you can setup Amazon.com to send your books directly to 1dollarscan.  The service will scan your books (you won’t get them back) and even upload them into dropbox.

One move lets you have digital copies of all your books.  If you want to share your book with a friend, copy your book, or make a copy of a photo from your text…you can!  And if you read a lot, 1dollarscan makes all those books you’ve been meaning to read much more accessible than ever.

 

 

(4) GotoMyPc

I had a few unique time management problems:  first, I never seemed to have the file that I wanted on hand.  Second, I would start building something on my 3D printer and would have to walk away.  This left me to wonder whether the file I was printing ever finished or just what happened to it.

GotoMyPC.com solves these unique problems and many other more common issues.  First, special files, printer access, and other issues can be reviewed as you login to your computer remotely.  GotoMyPC allows me to virtually sit at the keyboard for whichever of my office computers I need.

Whether I need to check in on a 3D print, get a file I left at the office, or access an application that I only have on my work PC, GotoMyPC has been a great time-saver.

Pro tip:  If you’re in healthcare, watch out…don’t violate HIPAA with your particular use of GotoMyPC!

 

 

(5) Voice Recorder HD

This iPhone app is just plain great.  You can dictate with great clarity into your iPhone while driving, through a bluetooth headset, or via the speakerphone feature.  (Hey, I’m NOT recommending that you concentrate on dictating while driving.  Use your own judgement!)

What’s so great about being able to dictate into your phone?  The Voice Recorder app easily uploads files into Dropbox…

…and, of course, you can share the Dropbox folder with a colleague or anyone else you’d like.

Transcription services are available online via Odesk.com, Peopleperhour.com, and many other independent contractor websites.  You can even find a transcriptionist who lives in another timezone, so it’s possible to have all your work transcribed while you sleep. The transcriptionist can download the file to transcribe and email it to you as a word document later in the day.  What a great way to blog, get office work done, or complete that next proforma for work.

It’s quick, effective, and is all because of stringing together these powerful, modern tools.  Remember, if you’re in healthcare, you probably want to use this transcription pathway for administrative work only where there’s no protected health information (PHI) involved.  After all, HIPAA constraints are important.

 

After a month of collecting data about just how many of my hours I wasted, it was time to find some new pathways to help me be more effective.  I hope you find the five tools above, along with suggestions about how to use them, useful for you in your everyday work flow.

 

Have some tools, tips, or workflow tricks that you use to work as efficiently and effectively as possible?  Let me know beneath!

 

 

 

 

How To Use Trauma Triage As A Test

By:  DMKashmer, MD MBA MBB FACS

 

You may have learned about concepts like sensitivity and specificity regarding diagnostic tests. These useful concepts can be applied to many ways we make diagnoses in Medicine. In this write up, let’s briefly review the concepts of sensitivity and specificity as they relate to the identification of injured trauma patients.

 

Sensitivity is “PID”

 

First consider sensitivity. Sensitivity is the chance that a test is positive in disease. An easy way to remember sensitivity is as “PID”. PID, here, does not stand for Pelvic Inflammatory Disease. It stands for the chance that a test is “positive in disease”. A triage system can be looked at in terms of the probability that is positive in disease. By this, I mean consider that you can evaluate a triage system based on how sensitive it is to identify significantly injured (ISS greater than or equal to 16) patients. After all, isn’t that the point of triage?

 

If we consider a critically injured trauma patient to have an injury severity score of 16 or greater, the sensitivity of the triage system can be described as the probability that a full trauma team activation occurs for a trauma patient who has an ISS of 16 or greater. This would indicate the sensitivity of the trauma triage system as a whole for significantly injured patients. Of course, as with any methodology, this one suffers from the fact that we use injury severity score to determine whether the trauma patient is critically injured. Injury severity score is, of course, retrospective.  This is always challenging because triage decisions are made in anterograde fashion with limited information and there’s always a certain signal to noise ratio.  But hey–you gotta start somewhere.  At least the ISS measure gives us that starting point.

 

Specificity Is “NIH”

 

Next, consider the specificity of a trauma system. Specificity can be remembered as NIH. NIH, here, does not stand for National Institutes of Health (or, worse yet, “Not Invented Here”). Instead, it stands for “negative in health”. The specificity of a trauma triage system may be regarded as the probability that it does NOT give a full team activation in patients who are NOT significantly injured. Again, if we consider that patients with an ISS of less than 16 are not critically injured, we would care about the probability that the trauma activation is not called in patients who have an ISS less than 16.

 

And Now To The Interesting Stuff…

 

The concepts of sensitivity and specificity can allow us to do some interesting things. We can create both the odds ratio positive and odds ratio negative for patients coming in the triage system. This would allow us to determine the probability that a patient entering the system with a certain pre-test probability of injury is classified appropriately as a trauma activation. We could also determine the probability that they will not be classified as a trauma activation. Remember, the odds ratio positive is defined as the sensitivity of a test over the quantity one minus its specificity (end quantity). That looks like:

 

OR+ = SN / (1-SP) where OR+ is the odds ratio positive, SN is sensitivity, and SP is specificity.

 

The odds ratio negative is defined as quantity one minus the sensitivity (end quantity) divided by the specificity.  Here’s that one:

 

OR – = (1 – SN) / SP, where OR – = odds ratio negative, SN = sensitivity, and SP = specificity

 

Therefore, the more specific the test, the smaller the odds ratio negative and smaller the resultant odds of a patient being critically injured given system activation. This is one useful conceptual way to make anterograde decisions or to conceptualize trauma.

 

Using Our Numbers To Make Decisions

Let’s pretend, for example, a trauma triage system has a 25% sensitivity for labeling severely injured trauma patients, and has a 98% specificity for labeling patients who do NOT have significant traumatic injuries as people who should NOT have activations.  Therefore, the odds ratios:

 

OR+ = 0.25 / (1 – 0.98), or 12.5

and

OR – = (1 – 0.25) / (0.98), or 0.76

 

Now let’s pretend EMS brings a patient, and the person determining whether to activate the system hears a lot of story and is unsure about whether to activate.  “Eh,” they say “it’s a 50 / 50 chance. I could go either way about whether to activate.” Let’s use our triage-as-a-test to see what happens in the scenario as we make anterograde decisions:

 

First, we assign a 50% probability to the likelihood that the patient has significant injures. After all, in this example, the person deciding whether to activate thinks it could “go either way.” This 50% is sometimes called the prettest probability.

 

To use the odds ratios, we need to convert the probability into odds.  Probability is converted to odds by the formula:

 

p / (1-p) = odds, where p = probability.

 

Here, that’s 0.50 / (1-0.5), or 1.  So that’s the “prettest odds”.  (The odds something exists before we run the test.)

 

Next, let’s pretend that the triage system / info / criteria / whatever-we-use says “Don’t activate!” So we use the OR- to modify the prettest odds:

 

(1)(OR-) = posttest odds; here, that’s (1)(0.76) or post-test odds of 0.76.

 

Last, we convert the posttest odds back to probability.  Probability is converted to odds by the formula:

 

o / (o+1) = probability

 

So, here, that’s (0.76 / 1.76) or 43%!

 

So, wait a minute!  The patient had a 50% chance (in the triage person’s mind) of being significantly injured before the triage test / criteria were used.  Now, after the triage system said “Don’t activate!” that patient still has a 43% chance of being significantly injured.  Is that a useful triage system?  Probably not, because it doesn’t have the ability to change our minds…especially about patients who may be significantly injured!

 

What lets us do that math?  It’s called Bayes’ Theorem, and it introduces how to use test information to modify probabilities.  Conditional probability is an interesting topic–especially when it comes to triage.

 

Next, let’s discuss a few more interesting ways to measure our triage system.

 

One interesting way to measure triage system is how often critically injured patients are not activated as full team traumas. This is one measure of “undertriage”. To use this measure, we would review the total number of trauma patients who did not have a full trauma team activation and who were significantly injured with an ISS over 16 and we would divide by the total number of patients who came through the system with an ISS over 16. This would demonstrate what probability, given critical illness, we had of identifying the patient improperly. Said differently, this answers the question, “What proportion of significantly injured patients were not identified by our trauma system?”

 

Another interesting method is the matrix method, or Cribari grid. The grid answers the question “What percentage of patients, among those who were not full trauma team activations, were severely injured?”

 

Both methods point to the same ultimate issue: a type of error called undercontrolling. This type two statistical error indicates the risk of NOT adjusting or under-recognizing something even when, in fact, that thing exists. The concept of under controlling can be challenging to completely understand. Consider the picture below.  It always helps me.

 

from flowingdata.com
from flowingdata.com

 

 

 

 

 

 

 

 

 

 

 

 

 

Therefore, when we talk about undertriage in systems, it is important to determine which measure we are going to adopt and how we are going to measure ourselves going forward. In new trauma systems, or minimally developed trauma systems, there are sometimes challenges with application of the Cribari grid. Trauma registries and other trauma data sources may not fully and adequately capture all trauma patients as some may be shunted to medical services or there may be other difficulties.  It’s important to work with physician colleagues and the entire team to learn what the triage measures mean and how different ones apply.

 

 

 

For more information regarding concepts in triage including type two errors and thoughts on trauma triage, look here.