ER-Forum Blog

Recommended Reading for the Week

Scribes Fill Documentation Gaps by Jeff Byers

"'While wages vary with experience, a scribe program is generally at least revenue neutral within a year, and typically increases a department's revenue after a year,' [Jason Ruben, Director of CEP America's scribe program] says, adding that using scribes to handle patient reports can decrease throughput times by 10 to 12 minutes."

Emergency Department Visits Down for First Time Since Health Care Reform by Rachel Zimmerman

"'Between fall 2006 and fall 2010, there were reductions in emergency department use overall (down 3.8 percentage points), frequent emergency department visits (down 1.9 percentage points), and the use of the emergency department for non-emergency conditions (down 3.8 percentage points). This is the first reduction in emergency department use among nonelderly adults in Massachusetts observed in the MHRS.'"

Discharged ER patients often miss instructions from CBC News

"People who are discharged from emergency departments are often unable to tell what symptoms should raise alarms and make them return to the hospital, a review suggests."

MacNeal Hospital: Focusing on Teamwork

Last week, we learned about MacNeal Hospital's efforts to build a cohesive ED team. Check out the video below to hear from the hospital staff on how CEP America helped to develop the ED's leadership.

Real life emergency department solutions: A look at MacNeal Hospital

MacNeal Hospital’s emergency department (ED) was suffering from a lack of morale. The ED physicians failed to align with the hospital’s goals and lacked the leadership to engage the staff. As a result, both the ED staff and the hospital’s administration were growing frustrated and the disorganization was affecting the ED’s performance. Their time-to-provider (TTP) hovered around 56 minutes, which in turn impacted their patient satisfaction scores.

After exploring their options, the hospital’s administration decided to bring in CEP America. “CEP America really blew away the competition,” recalls Brian Lemon, MacNeal Hospital’s CEO. “We respected their model and their philosophy about the kind of relationships they want to have with their physicians.”

CEP America enlisted the talents of Janet Young, MD, to serve as the ED’s new medical director. Working with the existing staff, she worked to bring CEP America’s culture to MacNeal Hospital. She reached out to the nursing staff and other ED technicians, seeking their input as CEP America worked to improve the ED’s operations. Working closely with Brad Buchner, MacNeal’s Director of Emergency Services, and Natalie Bonner, RN, the ED Nurse Manager, Dr. Young fostered relationships built on trust and mutual respect that has led to improved ED operations.

"When Janet wants to make a change, she comes to Brad and I and we discuss it,” praises Natalie Bonner, RN. “We’ve really come to form a strong management team, and Janet holds everyone equally accountable.”

The result of MacNeal’s strong leadership team has been reflected in the ED’s metrics. TTP has dropped to 25 minutes; the Left Without Being Seen (LWBS) rate fell from 3.4% to 0.9%; and patient satisfaction scores jumped to the 95^th percentile.

More than just metrics, though, MacNeal’s ED staff feels like they are a part of a unified team that can deliver efficient, top-quality care to their patients.

Recommended Reading for the Week

Most Vulnerable Patients at Risk for Not Being Seen by Gina Shaw

"Visitors to emergency departments that serve low-income and poorly insured patients are significantly more likely to leave without being seen than those who seek emergency care at hospitals with a more affluent patient population."

Solving information overload in the EHR by Neil Mehta, MD

"One potential pitfall of some EHRs is the number of steps it takes to find information that is in the system.  Yes, it may be easier to find than in an old paper-based system but it is still far from ideal.  Also there is a lot more information that is accessible."

Quit medicine? (part one) from EM Physician - Backstage Pass

"It is important to keep in mind that doctors have done themselves a huge disservice by subscribing to the current status quo of medical training. Unlike nurses, or PAs, we cannot just “switch” specialties and “do a new thing” when we get bored with the current thing, or otherwise we can no longer do certain procedures or function in certain capacities. . . Overall, medical education does not easily extrapolate into meaningful work outside of medicine. So, once you choose a specialty, you’re essentially stuck! A decision you make about your career at age 25 had better serve you well when you’re 50."

Real life emergency department solutions: A look at Sherman Hospital

By 2008, Sherman Hospital’s emergency department (ED) was experiencing a steady increase in patient volume, going from 41,830 in 2006 to 43,345 in 2008. Unfortunately, the current ED staff was having difficulty dealing with the rising number of patients. “Our team struggled to implement process improvements, improve patient satisfaction, and enhance employee engagement,” recalled Linda Deering, Sherman’s COO.

In addition to these operational barriers, Sherman was preparing to move into a brand new facility in early 2010; and the leadership knew that they needed to enhance the ED’s leadership and resources to adequately meet the demands that come with an expanded ED. So when their ED physician group recommended to hospital leadership that they merge with CEP America, CEP America’s proven and reproducible results made Sherman’s administration confident that they were a good partner for their new ED.

What Sherman Hospital received was not just a partner for the ED, but a partner for the entire hospital. “CEP America has a Partnership model,” says ED Medical Director Matthew Stilson, MD, referring to CEP America’s democratic structure. “That really means becoming a Partner with the hospital and to understand what their goals and needs are.”

CEP America’s culture of collaboration has led to an emergency physician on almost every committee in the hospital. By understanding all of Sherman’s operations, CEP America’s physician Partners are able to understand how the ED impacts the hospital, and in turn, how the rest of the hospital impacts the ED.

Since coming to Sherman at the end of 2009, CEP America’s impact on the ED has been extraordinary. In addition to reducing time-to-provider (TTP) from 69 minutes to an average of 28 minutes, patient satisfaction has reached the 91^st percentile, and the ED’s volume has continued to rise.

CEP America’s success in the ED and hospital-wide engagement has resulted in their practices being implemented throughout the hospital, including a Quality Assurance program led by the ED’s Assistant Medical Director, Michael Rosenberg, MD. “CEP America has gone out of their way to establish relationships with existing medical staff and outside organizations,” praises Ian Jones, Sherman’s VP of Clinical Performance. “Their depth of management and well-developed infrastructure encourages quality and satisfaction.”

And that standard of quality and satisfaction permeates the entire hospital.

Recommended Reading for the Week

The emergency depatment in an ACO world by Mark Crockett, MD

"In today’s ED, patients may enter with a chronic condition that could be better managed by a primary care physician (PCP), but because ED physicians are incented to treat sick people in a fee-for-service model, they continue to take these patients on instead of referring them outside the ED walls. If instead both ED and primary care physicians operate as part of a team of care givers that are incented to ensure patients stay healthy and avoid hospital admissions and readmissions, they are headed in the same direction in terms of focusing on better patient outcomes vs. reimbursement dollars."

Text-Messaging to Emergency Patients Might Reduce Their Alcohol Consumption

"'When we used text-messaging to collect drinking data and to offer immediate feedback and support to young adults discharged from the emergency department, they drank less,' said lead study author Brian Suffoletto, M.D., M.S., assistant professor of emergency medicine at the University of Pittsburgh in Pa. 'Each day in the U.S., more than 50,000 adults ages 18 to 24 visit hospital emergency departments and more than a third of them report current alcohol abuse or dependence. If not addressed, hazardous or binge drinking can lead to high rates of avoidable injuries and death.'"

Average Inpatient Hospital Stay Shorter but More Expensive in 2009 Than 1997 by Jaimie Oh

"In 2009, the average inpatient hospital stay was slightly shorter (by 0.3 days) but more expensive (by $2,600) compared to the average stay in 1997, according to recent statistics from the Healthcare Cost and Utilization Project. "

Recommended Reading for the Week

Crowded ERs help urgent care centers thrive by Phil Galewitz

"Urgent care centers' fees are at least half those charged at a hospital emergency department for the same condition, although they are similar to what physicians charge for office visits. Still, the savings in ER costs are a big draw for patients without insurance, as well as insured patients facing higher out-of-pocket costs because of rising deductibles. Those lower fees have also drawn the attention of hospitals and insurers — both of which increasingly see the facilities as a way to hold down costs and boost bottom lines."

Emergency departments are being established separate from hospitals by Michelle Andrews

"One increasingly popular option to improve access to services is the free-standing emergency department, a facility that, as its name suggests, isn’t physically located within a hospital. Services at these facilities get high marks, but questions remain about whether they’re the best choice for some serious medical problems. And some policy experts say the facilities may not be serving the people who need them most."

ER wait time pledges improve patient satisfaction by Karen M. Cheung

"[H]appier patients isn't the only reason for shortening wait times. Studies have showed that long emergency department wait times can mean adverse events. According to a study, published this summer in the British Medical Journal, long wait times are tied to more patient deaths and hospital admissions."

One Team, One Voice

Selecting and transitioning to a new physician group is never easy. It takes due dilligence by hospital administration to find a group that best aligns with the hospital's goals; and it is up to the incoming physician Partners to make the transition as smooth as possible.

When Sherman Hospital in Elgin, IL began moving into a new facility two years ago, the administration knew that they needed increased resources to meet the expectations that come with a new Emergency Department. After their own ED physicians recommended CEP America, Sherman Hospital called on them manage their ED; and in the process, found a group that worked to understand their hospital's needs and how to best meet them.

Limited Number of Seats Available for Free Webinar

We still have a few spaces left for CEP America's free webinar on implementing electronic medical records (EMR) using medical scribes on Thursday, December 1.

The emergency department (ED) faces a higher burden than other health care settings to successfully implement electronic medical records (EMR). As we move toward widespread EMR adoption, providers are looking for ways to bridge the knowledge gap and make the transition less cumbersome for physicians.

Since 2008, CEP America has used medical scribes to reduce an ED physician’s workload, increase productivity, and improve job satisfaction—particularly when working with an EMR system. Today, CEP America has over 20 EDs that employ over 250 scribes.

Register now for your webinar seat!

Recommended Reading for the Week

For-profit hospitals at higher risk for closing ERs by Karen M. Cheung

"For-profit hospitals and hospitals that serve black and Medicaid patients are more likely to close their emergency departments (ED) in California, according to a study published today in the Annals of Emergency Medicine. Fewer EDs were located in areas of poorly insured residents, and hospitals were more likely to add emergency capacity in suburban areas serving patients with private insurance, according to researchers of a retrospective study."

Nurse Practitioner Reduces Unnecessary Emergency Department Visits from Loyola University Health System

"Researchers found that the nurse practitioner reduced ED visits by improving the continuity in care and troubleshooting problems for patients. The addition of an NP also resulted in an improved use of resources and financial benefits for the health system."

One Idea for Reducing Health Care Costs: Keep Non-Emergencies Out of the ER by Kai Falkenberg

"To crack down on 'frequent flyers,' as patients who repeatedly use the ER are known, some states have adopted aggressive measures.  Washington state is trying to limit its Medicaid recipients to three non-urgent emergency room visits per year.  After that, they have to pay for the visits out of their own pockets."