PetrackConsulting.com

June 2006
Volume 4, Issue 4



Consultant's Corner
Feature Article
Quote of the Month
New Articles / Abstracts
In the News
Upcoming Meetings


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Consultant's Corner
Emory Petrack, MD, FAAP, FACEP

I just returned from the 2nd International Multidisciplinary Conference on Pediatric Procedural Sedation, held in Columbus, Ohio. I offered a workshop with Lisa, our child-life specialist, on "The Integration of Non-pharmacologic Techniques and Pharmacologic Approaches to Painful or Anxiety Provoking Procedures in Children."

While the workshop was very well received, what struck me most about this conference was the integration of a lot more than just pharmacologic and non-pharmacologic techniques. This meeting was a gathering of emergency physicians, intensivists, radiologists, hospitalists, nurses, child life specialists, administrators, and others who were all focused around the goal of improving the experience of procedural sedation for children and their families. The integration of multiple disciplines, focused around a single goal, brings tremendous power to any endeavor. This reality is increasingly recognized in disciplines ranging from cancer care to behavioral medicine. Integrating the talents of individuals from diverse disciplines in the service of improving emergency care just makes sense.


Feature Article

Where Does Your Department Focus its Energy?

It's not open for debate: we all waste time on activities that contribute little to the running of our departments. The real question is Where is that time and energy going, and how can we harness it?

A useful dynamic to examine is the difference between an external and an internal focus of attention. People only have a total of 100% of their energy to give your department. Unfortunately, it is the rare individual who gives close to 100%.

However, even an individual who gives a full 80% effort-perhaps not bad these days-may not be giving all that effort to truly productive energy. Instead of focusing entirely on the "external" work of the department-great clinical care, improving satisfaction, good documentation, connecting with patients and family-staff frequently focus instead on "internal" problems. Such concerns may include gossip, pay, evaluations, and personality issues.

Imagine the increased productivity that can come simply by helping the department move from an external to internal focus ratio of 60:40 to 80:20. It may be that there are just one or two individuals who keep the internal focus constantly in sharp focus. Or perhaps there's one "looming" issue that is gaining a lot of internal focus for the entire department. Either way, deal directly with those individuals or issues, and help get the focus back where it should be: on patients, families, and the various other "real" concerns and challenges facing the department.


In the News

Detroit Medical Center starts money-back guarantee, Detroit Free Press, May 2006.

National Emergency Department Inventory, Emergency Medicine Network, February 2006. This chart shows the distribution of ED volumes nationally and by state for 2001. Surprisingly, the median number of ED visits nationally is only 15,711, with a whopping 35% of EDs having an annual volume of less than 10,000 patients.

Gap widens in hospital patient satisfaction, Press-Ganey, May 2006.

Emergency Nurses Association Issues Call for Zero Tolerance of Violence in the Emergency Department, Yahoo News, May 2006.

In U.S Hospitals, Emergency Care in Critical Condition, Fox News, May 2006.


Quote of the Month

"We know where most of the creativity, the innovation, the stuff that drives productivity lies - in the minds of those closest to the work."
- Jack Welch, Former CEO, General Electric


New Articles/Abstracts

Brief summary of recent new articles and abstracts from http://www.PetrackConsulting.com/articles.html

Mohanty SA, Washington DL, Lambe S et al.
Predictors of on-call specialist response times in California emergency departments. Acad Emerg Med. 2006 May;13:505-512.

This study assessed waiting times for on-call specialists for 1,798 patients in 30 California EDs during a six month period. The vast majority (86%) responded within 30 minutes; however, 10% did not respond at all. In addition, after controlling for potential confounders, the authors found that for every $10,000 increase in hospital zip code income, the odds of a response within 30 minutes increased by 123%. They conclude that policy should focus on making more funding available for on-call specialists in poor areas.


Green SM.
Is there evidence to support the need for routine surgeon presence on trauma patient arrival? Ann Emerg Med. 2006 May;47:405-411.

Dr. Green, a noted researcher for highlighting old assumptions about the provision of sedation in emergency departments, once again has written eloquently on a challenging topic: the need for surgeon presence on trauma patient arrival. Many institutions grapple with the difficulty in implementing related policies. The American College of Surgeons has guidelines for trauma centers that require surgical presence for patients with potentially serious injuries. Yet, in looking at the literature, as well as systems in Europe and Canada, the evidence is lacking for such a need. This article, and its accompanying editorial, are well worth taking a look at.


Drendel AL, Brousseau DC, Gorelick MH.
Pain assessment for pediatric patients in the emergency department. Pediatrics 2006 May;117:1511-1518.

These authors examined the association between patient visit characteristics, pain score documentation, and analgesic use. Their data is based on the NHAMCS national survey (1997-2000), and included 24,707 visits. Younger age, self-pay, visits to pediatric facilities and non-injury visits were associated with decreased pain score documentation. Importantly, they found that documentation of pain score was associated with increased odds of analgesic (in particular, opioid) use. Overall, they conclude that infants and toddlers are at higher risk for not having pain score documentation, and that decreased documentation is associated with decreased analgesic use.


Upcoming Meetings

Sept 13-17, Emergency Nurses Association, Annual Meeting, San Antonio, TX
Conference Information

Oct 15-18, American College of Emergency Physicians, Annual Scientific Assembly, New Orleans, LA
Conference Information


About Our Organization

Created in 2003, Petrack Consulting is dedicated to helping physician and hospital leadership bring excellence to emergency services. We work collaboratively to fully understand our client’s needs, and then address programmatic initiatives with measurable outcomes. Our unique background in emergency medicine, administrative medicine, and organization development allows us to create uniquely effective solutions for enhancing emergency services.

Website: http://www.PetrackConsulting.com
Email: epetrack@PetrackConsulting.com


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© 2006 Petrack Consulting, Inc. All rights reserved. Permission granted to excerpt or reprint with attribution.