What does risk mean to you and how do you approach risky clinical scenarios? As EM docs, we encounter risk every day. In this episode, Dr. Scott Stuckey gives us a new perspective by breaking down several frameworks and vocabulary we can use to think about and mitigate risk.

Residents: Dr. Stuckey completed this podcast as part of his Kiehl Professional Development Grant. You can submit a Kiehl grant to support your professional passion too!

Guest: Scott Stuckey, MD. Host: Kim Bambach, MD. Editors: Kim Bambach, MD and Creagh Boulger, MD.

Key Take-Aways:

1. Volken’s Hazard Evaluator: Developed by Martin Volken, a professional mountain climber. Assign likelihood and the consequences. Risk = likelihood x consequence.





2. What is your lateral emotional driver? Emotion plays a role in how we make decisions and it’s important to be aware of this. In medicine, we try to make objective assessments. Lateral emotional drivers are not necessarily negative- they can be critically important in goals of care discussions, for example.





3. Graham’s Risk-Frequency Matrix: when you find yourself in a stressful situation, ask yourself which quadrant you’re in. That can help you understand where to put your attention to mitigate risk. High risk or low risk? High frequency or low frequency? For example, tooth splinting is low frequency low risk. Lac repairs are high frequency low risk. Intubation is high frequency high risk. Cricothyrotomy is low frequency high risk.





4. The GAR (Green-Amber-Red) Risk Assessment: components of the situation are assigned a color related to the level of risk (green=least risk, amber= moderate risk, red=high risk). If you’re in red, how can you move into amber? If you’re in amber, how can you move into green? This often comes down to good communication with your team.





5. The risky choice may still be the right choice for the patient.

References:

1. Martin Volken’s Hazard Evaluator – Pro Guiding Service. December 22, 2013. Accessed August 28, 2024. https://proguiding.com/blog/martin-volkens-hazard-evaluator/





2. Operational Risk Using the GAR Model. U.S. Fish and Wildlife Service. Accessed August 28, 2024. https://www.fws.gov/sites/default/files/documents/GARModelWorksheet_v20230103.pdf





3. High Risk, Low-Frequency Events in Public Safety – Today’s Tip from Lexipol.; 2021. Accessed August 28, 2024. https://www.youtube.com/watch?v=pIpRVLkv0rg