1. FACULTY NOTES
Patient seen and examined with housestaff. Treatment plan discussed.
I agree with note by housestaff and his assessment and plan.
PLAN/DIAGNOSES
Muscle spasms
D/C to home
Motrin 600 mg three times a day as needed for pain
Flexeril 10mg three times a day for muscle spasms
Heating pad as needed for pain
No heavy lifting for one week
F/U with PCP
Return to ED if worsening symptoms

2. FACULTY NOTES
Patient seen and examined. Treatment plan discussed. I agree with note
by housestaff and their assessment and plan.
Patient is a 57 y/o white female with history of NHL, recent PICC
line placement. Presents with one week right upper extremity
erythema with pain. No fever or Cough, with vital signs stable.
Right, upper extremity + 2-3 edema. Positive I & D,
no discharge.
PLAN/DIAGNOSES
Cellulitis/ Right arm swelling
D/C to home
F/U with Vascular Lab Monday or Tuesday @ 8am, 6th floor,
UHC Bldg. (bring consult sheet)
F/U with Dr. Lin on Tuesday – call him on Monday
Keflex 500 mg, 3 x a day, for 10 days
Return to ED if worsening symptoms

3. Microsystems: A Primer

4. What is a system?
“A system is the coming together of
Parts, interconnections and purpose”
Paul Plesk

5. A microsystem in health care
delivery can be defined as a small
group of people who work
together on a regular basis to
provide care to a discrete group
of patients. It has linked
processes, shared information,
and produces clinical outcomes.

6. An Emergency Department can be
thought of as a microsystem.
• Small group of people
• Provide education to a discrete
group of patients
• Has linked processes
• Has shared information
• Produces educational outcomes

7. An RRC can be thought of as a
Microsystem.
• Small group of people
• Provide reviews for a discrete group of
programs
• Has linked processes
• Has shared information
• Produces accreditation decisions

8. Substance is enduring; form is
Ephemeral.
Microsystems have a high S/F ratio

9. Microsystems are embedded in
Macrosystems.
They can be inhibited by
Macrosystems
They can be helped by macrosystems

10. Microsystems have boundaries
(membranes)
In biology interesting things happen a
the interface between membranes

11. Small Groups as Complex
Systems
Arrow, McGrath and Berdahl
Type of Group Ways to Help
• Crews • Rehearsals, specialty
expertise
• Task Forces • Deadlines and diversity
• Teams • Conflict management and
attention to interpersonal

12. Stacey, 1996
-
Chaos
Zone
Agreement Of
Complexity
+ Control
+ -

13. Characteristics of High-
Performing Microsystems
• Constancy of purpose
• Alignment of roles and training
• Interdependence of team
• Integration of information

14. Characteristics of High-
Performing Microsystems
• Measurement
• Investment in improvement
• Supportiveness of the larger system
• Connection to community

15. Task
In thinking about your role as key players
in the EDmicrosystem, develop as set of
behaviors that facilitate the development
of the microsystem and its contribution
to the macrosystem.