PetrackConsulting.com

Fall, 2007
Volume 5, Issue 5

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

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

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

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

Summer is over; I hope you enjoyed yours. I recently returned from two blissful weeks in Cape Cod, our yearly vacation getaway.

The bliss didn't last long. Before settling back into work, I tried to backup my laptop. Instead of the normal "backup completed successfully" message, I got a "read/write" error. I know Macs quite well. But even after throwing all my technical might at that computer, it was dead. Turns out the hard disc had crashed and the only remedy was to return it to Apple for repairs.

So I did. And now I have a new hard disc, sans data.

I'm pretty good at remembering to backup, but even that wasn't enough - the hard disc crashed during a backup, resulting in the loss of the backup itself.

Fortunately, I also use an online backup service to store critical data off-site. Excuse me for saying so, but that redundancy saved my butt!

I haven't written much about technology here, and even though you've heard it before: backup your data! And consider redundancy, as you might experience a problem with your primary backup. The bottom line is this: how will you feel, and what will be the consequences, if you lose the reports, writings and data you consider most essential?

Most people still don't backup; most computers do eventually crash. Do the math.

Feature Article

Focus on First Impressions

First impressions count… a lot. It's been said that first impressions are formed during the first seven seconds of an encounter.

In the emergency or urgent care setting, first impressions are usually formed well before a patient sees a physician or mid-level provider. Parking "challenges" and encounters with security or other personnel can significantly affect feelings and expectations. However, it is often the triage nurse that sets the tone - positive or negative - for the entire visit. The condition of the physical facility also significantly impacts that first impression.

If a family sees a clean, inviting facility and connects well with the triage and registration staff, they are primed for a good experience with the physician or other provider. On the other hand, if they sense that the people in triage and registration don't care, then their visit is off to a poor start. The physician will now find assessment more difficult. And any delay in x-rays or labs will markedly increase frustration. Worst of all, it even may be impossible to turn that negative first impression around.

So how can you create an environment that supports positive first impressions?

    1. Keep the department clean and neat. As obvious as it sounds, I've seen departments on both ends of the spectrum so I think it's worth mentioning. An untidy department does not create a welcoming environment. It is essential to budget as necessary to keep the department in tip-top physical shape.

    2. If your department or urgent care center sees a significant volume of children, create an environment that makes it clear that children and families are welcome. Appropriate posters, toys and services show parents that your facility is comfortable with pediatric care. It's also essential that triage staff understands how to make children of different developmental ages feel comfortable. Good communication here is not only great for the children, but it also sends a message to families that your institution is family-centered.

    3. While communication is always important, it's that initial conversation that sets the stage for the entire visit. A patient or family member will pick up negative vibes very quickly if they are not made to feel welcomed. It may be appropriate to develop scripts and/or procedures for this initial encounter to ensure appropriate communications take place.

    4. Move the patient back into the patient care area as quickly as possible. Emergency departments that have transitioned to this procedure have experienced significant increases in patient satisfaction.
In short, take time to assess the initial experience from the patient and family perspective, and make changes that will enhance this critical moment of truth.

In the News

Survey Reveals Nurses' Dedication, Frustration Associated With Their Jobs, Medicalnewstoday.com, September, 2007.

Emergency Department Kiosks Offer Short Patient Check-Ins, Medicalnewstoday.com, September, 2007.

Rating Your Pain From 0 To 10 Might Not Help Your Doctor, Medicalnewstoday.com, September, 2007.

Physicians Report Growing Dissatisfaction With "Business" of Medicine, Yahoo Finance, September, 2007.

Health Care Spending Highest In Northeastern U.S., According To CMS, Medicalnewstoday.com, September, 2007.

Warning: Keep Mobile Phones Away From Hospital Beds,, Medicalnewstoday.com, September, 2007. (I include this story, as I know there has been controversy on some of the listservs.)

Quote of the Month

A lot of companies have chosen to downsize, and maybe that was the right thing for them. We chose a different path. Our belief was that if we kept putting great products in front of customers, they would continue to open their wallets.
- Steve Jobs, Apple Computer

New Articles/Abstracts

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

Hsiao, A. L., Santucci, K. A., Dziura, J., et al.
A randomized trial to assess the efficacy of point-of-care testing in decreasing length of stay in a pediatric emergency department.
Pediatr Emerg Care. 2007 Jul;23:457-462.

Point of care (POC) laboratory testing is one enhancement that emergency departments use to reduce throughput times. This is a prospective, randomized, controlled trial of pediatric patients requiring blood work. Of 225 patients, 114 were randomized to the POC testing group, and 111 to the routine blood testing group. Significantly less time was required for results to become available with POC vs. routine testing (5 vs 70 minutes; p<0.001). A significant decrease of 38.5 minutes (p<0.001) in length of stay was also noted. The authors conclude that POC testing is effective in improving throughput time and improving patient flow.


Holroyd, B. R., Bullard, M. J., Latoszek, K., et al.
Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trial.
Acad Emerg Med. 2007 Aug;14:702-708.

Many processes have been explored for improving patient flow to reduce ED overcrowding. In this study, a "triage liaison physician" (TLP) was placed in triage, whose role was to initiate patient management, assist triage nurses, answer medical consult or transfer calls, and manage ED administrative matters. The study was divided into three 2-week blocks. Within each block, 7 days were randomized to TLP shifts, and the other 7 days to control shifts (no TLP). Overall, length of stay was reduced by 36 minutes (4.3 vs 5 hours; p<0.001), along with a modest decrease in left without being seens. Although there are some important limitations to this study, it is an article worth reading and a process change worthy of consideration.


Kanter, R. K.Moran, J. R.
Hospital emergency surge capacity: an empiric New York statewide study.
Ann Emerg Med. 2007 Sep;50(3):314-319.

Disaster planning and preparation for major surges in ED volume remain challenges for most EDs. Current national standards call for hospitals to accommodate surges of 500 new patients per million population in a disaster. This article presents data from New York State hospital occupancy rates and estimates the ability to accommodate new patients. Total hospital beds for the period studied included a peak capacity of 2,707 children and 46,613 adults. Based on calculated average occupancy rates, there was an average statewide capacity for a surge of 268 new pediatric and 555 adult patients per million population. The authors conclude there are insufficient pediatric beds to meet disaster needs, and suggest that modified standards may be required to meet pediatric needs during a mass-casualty event. Clearly, other states may also have insufficient surge capacity.


Upcoming Meetings

Oct 8-11, 2007, American College of Emergency Physicians Scientific Assembly, Annual Meeting, Seattle, WA
Conference Information

Oct 26-27, 2007, Urgent Care Association of America, Fall Conference, Chicago, IL
Conference Information

Feb 28- March 2, 2008, Emergency Nurses Association, Leadership Conference, Honolulu, HI
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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