Waiting to Be Seen: Where EM Policy Meets Practice is an EM Cases blog series, authored by Dr. Howard Ovens, a veteran Emergency Department Director, whose main purpose is to share ideas and generate discussion on the role that public policy and administrative practices play in creating the conditions that help front line emergency providers achieve better patient outcomes. You can contact Dr. Ovens at [email protected] and follow him on Twitter at @HowardOvens.
A New York Times article titled “How Measurement Fails Doctors and Teachers” went viral on social media in January and caused a lot of chatter in medical circles. Its author, a professor of medicine at the University of California, gave voice to a wide sense of frustration, and while I understand that feeling and think it’s justified, I don’t agree with labelling measurement as the culprit. As I expressed in my first WTBS blog post, “Why Recording Time to Initial Assessment is Worthwhile,” I believe my job as an administrator is to make the job of my staff easier, and measurements can help us maintain standards of care and understand where gaps in the system may exist—when such data are collected and used appropriately. In this guest blog, Dr. Lucas Chartier, an emergency physician in Toronto with a background in quality improvement, expands on the subject of how we’ve gone off course in our zeal for measurement and helps us try to find the path back to our intended goals.
In Emergency Physician Speed How Fast is Fast Enough – Part I, Dr. David Petrie addressed the issue of physician productivity (patients per hour, or PPH), the many factors that influence how quickly emergency physicians can process patients, and some of the tradeoffs between speed and quality. He also discussed the processing rate of the entire ED and introduced the concepts of surge capacity and the effect of crowding on safety if the ED can’t keep up. In this follow-up blog, Dr. Petrie expands on the departmental aspects of throughput and safety, and calls on policy-makers to recognize the need to include surge capacity in planning efforts. He also makes some powerful arguments about the related issues of so-called 'inappropriate visits' and the changing role of the ED. In this post - Emergency Physician Speed Part 2 - Solutions to Physician Productivity , he also brilliantly dismantles some common myths about ED visits — and drivers of costs.
Racing legend Mario Andretti famously said, “If everything seems under control, you’re just not going fast enough.” He was talking about cars, but to many beleaguered emergency physicians trying to keep up with the patient queue, emergency medicine often seems this way. This guest blog on emergency physician productivity began as a question to our national association, the Canadian Association of Emergency Physicians (CAEP): Are there any national standards with respect to emergency physician productivity, i.e., expected number of patients assessed per hour? The question was referred to the CAEP Public Affairs Committee and triggered a lively email discussion among our members....
I view the emergency department as a safe refuge, a modern-day secular sanctuary. We are the one health-care service that never turns anyone away; we provide shelter to the homeless on cold winter nights, safety for battered women, and food for the hungry. I have always felt this “sanctuary” role was part of the core mission of the ED, one with a great potential for improving lives, or at least providing comfort.
Funding and freeing the future of learning that is FOAMed Longtime followers of EM Cases will have noticed a progressively prominent display on its website of the logo and inclusion of the name of [...]
As both an emergency director and a practising emergency physician, I believe it is the job of administrators to make the challenges of front line staff easier, not vice-versa. Clinicians are too busy taking care of patients to perform purely administrative chores. But one task that I would ask all emergency doctors to adopt is the step of recording the time of Physician Initial Assessment, or PIA times. The time from arrival until they first see a physician is what most patients consider their ED wait time, and it is an important metric to report. Yes, it means one more small box to fill out in your charting, but it can be of huge benefit to doctors. Allow me to explain why....