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 Mar/Apr 2007 Volume 5, Issue 2
 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 Urgent Care Association of America annual conference, to be held May 9-12 in Daytona Beach, FL (see the Upcoming Meetings section for details). His topics will be "Common Presenting Complaints and Clinical Pearls in Pediatric Urgent Care" and "Approach to the Pediatric Rash."
For free articles, abstracts, Emergency Care Briefs, and more, visit our Resource Center at PetrackConsulting.com...
CalmerKids: the first ever CE training module that changes how your facility serves children and their families... Show me... |
Consultant's Corner Emory Petrack, MD, FAAP, FACEP An important article just published in February's Academic Emergency Medicine discusses the changes in pain management for long bone fractures before and after the 2001 JCAHO standards were implemented. The good news is that there do appear to be increases in analgesic use since 2001, although only a relatively small increase in narcotic analgesic use. That said, there is still significant room for improvement, with about a quarter of patients still not receiving analgesia (and nearly half not receiving narcotic analgesia). During my talk last week at the ENA Leadership Conference in Boston, I focused, in part, on creating a culture that supports pain management; the next Spotlight on Emergency Care will focus more on this critically important topic. Although we continue to make strides, addressing pain correctly and consistently in emergency and urgent care settings remains an unmet goal for many centers.
Feature Article Creating and Exceeding Expectations
I was quite surprised, but not shocked, when my new Macbook arrived Friday morning at 8:45. After all, Apple is a company well known for its great customer service; I've been a loyal, card-carrying Mac user since 1985.
I ordered that computer on Tuesday, a mere three days before delivery. My order included a request for a memory upgrade and other "customization" options, which changed shipping from "ships same day" to "ships in 2-3 days." So it was great to see in an e-mail on Wednesday - the very next day - that my computer had shipped. A tracking number was included, showing delivery by FedEx the following Monday. Given that the computer was being shipped from Taiwan, I was quite pleased that my shiny new laptop would be here so soon.
FedEx - another great company - appeared at my door less than 48 hours later. Is this the way Apple delivers computers to all its customers? Of course it is. And that's pretty impressive service. But where Apple and FedEx really excel is in creating reasonable expectations, keeping customers informed as to the progress of keeping those reasonable expectations, and then exceeding them.
Every day patients who have had positive customer service experiences with companies like Apple and FedEx come into your emergency department. Based on their encounters, they compare you not to other emergency departments, but to all other customer service experiences. What are they going to tell others about their experiences in your facility?
We need to set reasonable expectations and exceed them, and do it consistently, in our departments. When radiology or labs will be delayed 30 minutes, apologize to the patient and let them know it will be an hour - they will be delighted if it's less time.
You know this already, so why do I highlight this concern here? Two reasons: 1) you may know it, but do all staff in the ED know it? And 2) is it actually put into practice on a consistent basis? The technique is obvious and simple, but means nothing if not consistently implemented. If it is, however, you'll find more and more that patients are surprisingly pleased at how your facility always seems to be able to exceed expectations.
In the News
Quote of the Month
New Articles/Abstracts
Brief summary of recent new articles and abstracts from http://www.PetrackConsulting.com/articles.html
Falvo T, Grove L, Stachura R et al.
The objective of this study was to establish a method to quantify the revenue lost as a result of patient elopements (left without being seen) and ambulance diversion. It is a retrospective, descriptive study in one institution with an annual volume of 62,588 patients in fiscal year 2005. The study describes the assumptions made regarding patients not seen as a result of overcrowding, and applies these financial assumptions to this population. The result for this ED was a net revenue loss of nearly $4 million during the 12 month study period. While studies utilizing financial assumptions applied to a group of patients for whom data are lacking has limitations, this methodology demonstrates specific and significant net revenue loss from systems problems commonly encountered.
There is little information on the use of procedural sedation in community emergency departments. This study examines 1,028 procedural sedations on 980 patients from 14 community ED study sites. Ages in this study ranged from 1 month to 95 years. A wide variety of sedating agents were used. Complications occurred in 4.1% of cases, with serious complications, such as assisted ventilation, occurring in 1.1% of cases. All complications were managed by the ED physician, and none required a change in disposition. They conclude that procedural sedation in the community ED setting appears to be safe and effective over a wide range of procedures and ages.
This policy statement from the American Academy of Pediatrics highlights the problems surround the provision of emergency care for children, along with specific recommendations.
Mistaken or delayed diagnoses contribute significantly to ED malpractice claims. This study looked at 79 closed ED malpractice claims to discern attributes and patterns leading to risk. Forty-eight percent of cases were associated with serious harm, with 39% resulting in death. Most diagnostic failures were the result of multiple contributing factors. Of note, the leading factors contributing to missed diagnoses were: cognitive factors (96%), patient related factors (34%), lack of appropriate supervision (30%), inadequate handoffs (24%), and excessive workload (23%).
Although pain management continues to receive national attention, it is unclear how the JCAHO 2001 standards have impacted this important area. This is a retrospective study of the National Hospital Ambulatory Medical Care Survey (NHAMCS), comparing pain management for long bone fractures for the period before, and after, the new standards were implemented. Overall, analgesic use for this population increased from 56% to 76%, and opiate use increased from 50% to 56%. It appears that while there are increases in use of analgesics, there is still significant room for improvement.
Upcoming Meetings
April 17-19, 2007, American College of Emergency Physicians, Advanced Pediatric Emergency Medicine Assembly, New York,, NY
May 9-12, 2007, Urgent Care Association of America, National Conference, Daytona Beach, FL
May 16-19, 2007, Society for Academic Emergency Medicine, Annual Meeting, Chicago, IL
Sept 26-29, 2007, Emergency Nurses Association, Annual Meeting, Salt Lake City, UT
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 |
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