PetrackConsulting.com

Sept/Oct 2006
Volume 4, Issue 6



Petrack Consulting exhibitor at ENA next week!

Dr. Petrack and Lisa Perry, our child-life specialist, will be at the Emergency Nurses Association annual meeting in San Antonio, TX, from September 14-16. We will have information about our consulting and training services, as well as video clips from our CalmerKids Training Module. If you're at the conference, stop by at Booth 1328 and say hello!


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


Upcoming Conference:

Dr. Petrack will be speaking at the Emergency Nurses Association Leadership Challenge, to be held February 22-25, 2007 in Boston, MA (see the Upcoming Meetings section for details). His topic will be "Through the Eyes of Children and Families: How to Enhance Your Department's Emergency Care."


For free articles, abstracts, Emergency Care Briefs, and more, visit our Resource Center at PetrackConsulting.com...

Click here...



CalmerKids: the first ever CE training module that changes how your facility serves children and their families...

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Beginning this month, Spotlight on Emergency Care will be emailed bi-monthly. Articles and abstracts will continue to be updated at Petrack Consulting as they are published, and will be highlighted in Spotlight as well.



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

I was recently on a full flight to San Francisco, and found myself in that undesirable middle seat. Fortunately, this was mitigated by my good fortune to sit next to a wonderful woman, 79 years young. She was off to her grandson's wedding in Honolulu.

She had been advised that her connection would be rather tight, and she would do well to bring only carry on luggage. She told me that as she got on the plane, she requested assistance from one of the flight attendants in putting her bag in the overhead storage. The flight attendant's answer: "If you can't put it up there, you'll need to check it in with the regular luggage." Fortunately, it seems another gentleman overheard this conversation, and offered his assistance in putting the bag overhead, as well as letting her know that he'd be happy to help take it down after the flight.

Amazing. Or perhaps not so amazing. It is so easy... so quick… to put out a remark that screams "we don't care." And although it may be an individual putting out the remark, it's always the "we"… the organization… that is associated with the poor service. A story like this can serve to remind ER staff of the impact of their words, and their attitudes, on patients.


Feature Article

Get the Right People and the Rest Will Follow

I just read Jim Collins' widely acclaimed book Good to Great. Collins examines the differences between several "great" companies that significantly outperformed the market with "good" companies in the same industry. His idea was to identify the characteristics that led to the enhanced performance of the "great" organizations.

Part of what he found-that variables in three broad categories differentiate the great from the good-is highly applicable to those of us in emergency medicine. While I'm significantly oversimplifying Collins' findings, those categories are: 1) the people in leadership positions, 2) confronting reality and maintaining focus, and 3) creating a culture of disciplined action. Let me focus briefly on the starting point, and what I believe is most crucial to us as well: the people.

Using Collins' framework, we can say that being a "great" emergency care facility basically boils down to two things: getting the right people "on the bus" and the wrong people "off the bus." It may sound simple, but staffing is a complex, relevant issue; we spend a huge amount of time and energy developing protocols and policies, troubleshooting problems and putting out departmental fires. And frequently, we find that our time and energy is focused on a few individuals who cannot work collaboratively or, in some other way, are just not a good match for helping the department move forward.

It may not be pleasant or easy, but we must address these "people" issues honestly and directly if we are to achieve our forward-looking goals for the department. Getting the wrong people off the bus is ultimately good not only for the institution, but for those "wrong" individuals as well-after all, everyone deserves to be in a setting where his or her unique talents and strengths can flourish. And when we have the right people on the bus, we will move forward. We also need to celebrate that match and make sure that they and others in the organization know it.


In the News

Study: Watching cartoons eases children's pain (during procedures), Medicinenet.com, August 2006.

MRSA most common cause of skin infections in nation's emergency rooms, Science Daily, August 2006.

Record numbers of Americans lack health insurance, medicinenet.com, August 2006.

New Orleans' health-care system still in tatters, medicinenet.com, August 2006.

Staff, bed shortages blamed for waiting-room miscarriage, Yahoo News (Canada), August 2006. While this occurred in a Canadian ED, given general conditions of overcrowding, it could easily happen elsewhere.


Quote of the Month

"The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club wont be worth a dime."
- Babe Ruth


Special Section: Institute of Medicine Editorials

The following links are to 3 key editorials published in the August Annals of Emergency Medicine. Each editorial addresses one of the major areas related to the future of emergency medicine, recently published by the IOM:

Asplin BR.
Hospital-based emergency care: a future without boarding?
Ann Emerg Med. 2006 August;48:121-125.


Spaite DW.
The future of emergency are in the United States: The Institute of Medicine subcommittee on prehospital emergency medical services.
Ann Emerg Med. 2006 August;48:126-130.


Gausche-Hill M.
Integrating children into our emergency care system: achieving the vision.
Ann Emerg Med. 2006 August;48:131-134.


New Articles/Abstracts

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

Rowe BH, Channan P, Bullard M et al.
Characteristics of Patients Who Leave Emergency Departments without Being Seen.
Acad Emerg Med. 2006 August;13:848-859.

Patients who leave the emergency department without being seen (LWBS) frequently present a clinical and financial concern for hospitals. Sampled data were obtained from 2 Canadian hospitals (one pediatric, one adult), resulting in 711 LWBS patients during 77 days of sampling (4.5% LWBS rate). Not surprisingly, the most common reason for leaving was "fed up with waiting" (45%). Of the LWBS patients, 60% sought care within 1 week, 14 were hospitalized, and one required urgent surgery. They conclude that while complications are rare, LWBS can be associated with adverse outcomes.


Hunt KA, Weber EJ, Showstack JA et al.
Characteristics of frequent users of emergency departments.
Ann Emerg Med. 2006 July;48:1-8.

Using data from the 2000-2001 Community Tracking Study Household Survey, these authors examined adult ED visits, defining a frequent user as having 4 or more visits. The 8% of users with frequent visits were responsible for 28% of adult ED visits. The vast majority of frequent visits (84%) had health insurance and a usual source of care (81%). Characteristics associated with frequent use included poor physical health, poor mental health, 5 or more outpatient visits annually, and family income below the poverty threshold.


McConnell KJ, Richards CF, Daya M et al.
Ambulance diversion and lost hospital revenues.
Ann Emerg Med. 2006 July; in press.

Ambulance diversion is well known problem faced in many emergency departments across the country. This article examines hospital revenue lost for each hour of ambulance diversion at an urban, academic ED. Each hour on diversion was associated with $1,461 in lost hospital revenue. Increasing ICU beds resulted in a significant decrease in ambulance diversion, resulting in more patients, and $175,000 in additional monthly revenue.


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

Feb 22-25, 2007, Emergency Nurses Association, Leadership Challenge, Boston, MA
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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