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practice setting transition

Practice Setting Transition | Moving from Urgent or Primary Care to the Emergency Department

My first practice setting was in an emergency department.  I had always worked in the ED as both a nurse and an EMT.  The emergency department is where I find the most comfort of practice.  Prior to starting in that first practice setting, however, I was asked about my skills portfolio by the recruiter.  I had done the minimal amount of suturing and urgent care required to earn a graduate degree in nursing, and my ED background supported an ability to work with emergent cases.  But the central question that would be on the minds of the credentialer and hospital board was whether I was competent to serve in a critical care area as a provider.

After a review of my CV, which highlighted my skillset and the value propositions I believed would win me my first service posting, I was encouraged to take the Emergency Medicine Boot Camp.

This course was fantastic and I cannot say enough great things about it.  I entered the boot camp a provider-novice and exited with an array of perception, diagnostic, and assessment tools that brought me to a point where the intense and steep learning curve of being a provider in the ED was manageable.

After a few months of working in the ED practice setting I realized that my total lengths of stay were increased most, in fact bottle-necking, when suturing or wound repair was involved.  I did not have enough of an underlying skill-set or speed of practice when it came to this crucial ED (and urgent care) procedure.  I was great at the old standard simple-interrupted.  But I was forgetting this or missing that with assessment or consultation.  It was the things I didn’t know that I didn’t know that honestly scared me.  What was I going to miss because of lack of knowledge in the areas of assessment, diagnostics, or procedures that would land me in court or, worse, really harm someone?

It was then that I began to dig into the data.  Books like Alexander Trott’s Wounds and Lacerations.  Journal articles such as R. Preece’s (et al.) 2015 publication in Medical Education Online that found 81% of medical students believe they received insufficient suturing and wound repair training in medical school.  And, like most of us, a kazillion Medscape, Epocrates, and NIH / PubMed articles.

I began to see a trend in laceration repair, suturing, and wound care that pointed to a method.

Getting through nursing and graduate school consisted of finding neat ways to stuff as much information as I could into mnemonics.  So, I did just that with the method I saw before me in the data.  I stuffed as much information as I could into the letters C, E, F, A, S, A, T, and C.  After some rearranging, I decided “CAFE SCAT” wouldn’t work, and again rearranged.  As it turns out, A.C.E. F.A.S.T. Closure fit nicely, so I registered this mnemonic, learned how to shoot the best possible digital video, wrote, and then produced a course that would teach this mnemonic.

The end result is OSC.  It’s my best effort to positively affect my profession and enhance the training of my colleagues, especially those who work in urgent or primary care, or emergency departments.

If my benchmark question is, “Would I take this course?” then I have met my own benchmark.  I’m a coffee snob, a water snob, and a CME snob.  I nit-pick CME courses to no end, sometimes, if I have a problem with the presentation or the facts presented.  Using my CME snobbery as a standard applied to my benchmark question, I still answer “Yes, I would take this course.”

I encourage you to consider adding OSC to your CE portfolio.  Doing so will enhance your skill-set, expand your marketability, and will help to answer that question of competence when asked by a recruiter, a hospital board or, most importantly, by you about yourself.

suture training course

20 Total CE Credits

  • 11 Closure Methods
  • 10 Exciting Case Studies
  • 11 Hands-on Practice Modules
  • Closure Basics Including Line and Needle Selection
  • When and When Not to Close
  • The A.C.E. F.A.S.T. Closure® Method
  • Anesthesia Including Local Infiltration, Field Blocks, and Digital Blocks
  • Proper Wound Cleansing
  • Proper Wound Examination
  • Foreign Body Removal
  • Antibiotic Appropriateness
  • When to Seek Surgical Consultation
  • Current Tetanus Guidelines
  • Proper Knot Tying
  • Multi-layer Suturing
  • Repair of Torso Lacerations
  • Repair of Extremity Lacerations
  • Repair of Head and Neck Lacerations
  • C-spine Management and Imaging Related to Traumatic Head and Neck Lacerations
  • Dog Ear Deformity Correction
  • Undermining
  • SPECIAL TOPIC: Pediatric Lacerations
  • Repair of Scalp Lacerations
  • Repair of Eyelid Lacerations
  • Repair of Ear Lacerations
  • Repair of Lip Lacerations
  • Treatment of Open Fractures
  • Repair of Nailbed Lacerations
  • Repair of Flap Lacerations
  • Repair of Buccal Lacerations
  • Repair of Tongue Lacerations
  • Repair of Joint Capsule Lacerations
  • Treatment of Animal Bites
  • SPECIAL TOPIC: Lacerations in the Anticoagulated Patient
  • SPECIAL TOPIC: Managing Poorly Healing Lacerations
  • Appropriate Follow-up Care
  • Medicolegal Tips and Nuggets
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