Life in the ER

Culture Change in the Bristol Emergency Department

After five months of helping to manage the emergency department at Bristol Hospital, it is tempting to talk about the various changes in the department - our metrics, efficiencies, ongoing efforts to improve throughput, or our relations with nursing, ancillary services, and other departments within the hospital. But I fall back on the one factor that I believe makes it possible for us to positively impact all those other factors: our culture.

Company culture is notoriously difficult  to pin down. It expresses itself through the people, everyone from a company’s top leadership, which has been making frequent trips to Bristol to staff shifts in the ER, all the way through the nurses, APPs, receptionists, and janitors that help make an ER run smoothly.

Observation Medicine Playing Bigger Role in the ER

Traditional observation units often focus on chest pain and a few other diagnosis. But as the health care market continues to change, so has the need to decrease length of stay, decrease re-admissions, and streamline patent care.

Accordingly, MEP’s Observation Services at Western Maryland Health System continues to grow. We have physically expanded from ten to twenty beds and we have expanded the scope and complexity of the type of patients we care for as well.

The Decline and Fall of Triage in the ER

The national trend toward overcrowding in emergency rooms is having an interesting effect on a process that was conceived to handle a large number of injured patients: triage. One might expect that as more and more patients flow into the ER, the process of triage would become even more central to the smooth flow and efficient management of an emergency department. In fact, the opposite is the case, and for one simple reason: the new patients flooding the ERs generally aren’t having an emergency.

Medicaid Rule for Emergency Departments Used a Hammer to Tighten a Screw

There are a thousand places to look for cost savings in healthcare, but this week in Washington State officials grappled with one of the most visible of those: emergency care.

Thankfully, Washington Governor Christine Gregoire has suspended implementation of a rule that would have denied emergency rooms payment from Medicaid if the patient was diagnosed with a range of certain diagnosis deemed to be non-emergencies. The problem with that strategy is that neither the patient nor the physician knows whether the chest pain a patient walks in with is something serious like a heart attack, or something not so serious, like acid reflux.

5 Strategies To Head Off Malpractice Claims in the ER

I have always had an interest in risk management in the ER, a world in which it is a statistical inevitability that there will be bad outcomes. This interest stems from my fundamental belief that Emergency Physicians are well-intentioned, morally upright individuals. And so it frustrates me when some bad outcomes lead to malpractice litigation.

That said, my experience as an expert witness in over 30 medical malpractice cases and as chair of MEP’s RIsk Management Committee has taught me that, as in health care in general, Ben Franklin’s famous dictate that “an ounce of prevention is worth a pound of cure” is true when it comes to malpractice prevention as well.

Leadership in the ED: Being a Floor General for Your Team

In sports, the most successful athletes are not necessarily those that have had the best individual statistics, but are those that have managed to make their teammates better around them: Magic Johnson, Isaiah Thomas, or to use a hot new name - Jeremy Lin. 

These athletes epitomize selfless leadership on the court. While their own talent is unquestioned, their biggest success was, and in the case of Lin, is, how they influence their teammates, bringing out their best. They are floor generals. Even though they may be able to score alone, they understand when it makes more sense to pass the ball instead, as this can maximize the strength of the entire team. They make sacrifices to their own statistics, keeping the main goal in mind: to win.

America’s Healthcare System Needs a Social Contract

As a citizen it’s easy to clamor for rights. It’s much harder to live up to our responsibilities. And so it is in health care. 

As citizens we have implicitly agreed to abide by a social contract, which means a person’s moral and political obligations are dependent on an agreement among them to form the society in which they live. In other words, I am willing to “give up” certain things, such as complete freedom to do as I want, in exchange for which I gain the right to live in a protected society.

When Are ER Docs Hunting the Snark?

The old saying about the doctor who tells a patient to “take two of these and call me in the morning” is losing its meaning in today’s modern healthcare system. Today, doctors are weary of sending their patients home without something more, usually an expensive test that either confirms or (less commonly) contradicts their diagnosis.

Consider, for example, the gap between patient and their physicians in the following three instances, all involving strokes or potential strokes.