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 Spring 2009 Volume 7, Issue 2  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...
New, revised CalmerKids Training Module! Get a new low price, plus become CalmerKids Certified when training is complete. Show me...
Dr. Petrack will be writing a new quarterly column, Pediatric Urgent Care, in the Journal of Urgent Care Medicine. This column will focus on both the clinical and business aspects of urgent care medicine, as they relate to care for children and families. Check out the first column, to appear in the April publication, at JUCM.com.
Dr. Petrack will be present at the Urgent Care Association of America annual conference, to be held April 20-23 in Las Vegas, NV (see the Upcoming Meetings section for details). Come by and visit us at Booth 703 for free resources to help your urgent care practice, and for a discount on our CalmerKids Training Module. |
Consultant's Corner Emory Petrack, MD, FAAP, FACEP
Happy Spring!
Did you know that, in addition to my being an emergency physician, I'm also a pilot and flight instructor? So it was with great interest that I watched the recent unfolding of the US Airways crash into the Hudson. In fact, when it happened, I was sitting at an airport gate in Providence, Rhode Island, just 45 minutes out from departure. As you can imagine, my anxiety meter shot up rather high, given that I needed to board the plane without yet knowing the details surrounding the unfolding crash.
As the popular press has pointed out, we can learn many lessons from this incident - as well as from Captain Sully's calm leadership, which led to the final, positive outcome. In this edition of Spotlight, I'll highlight a few lessons learned as they relate to our business of providing emergency and urgent care services.
Feature Article
Lessons from the Cockpit
In the last issue, I discussed how we often perceive many incidents, such as the current economic collapse, as unexpected, even though signs of trouble appear on the radar screen well before an actual crisis or adverse event occurs. The problem is that, if we're not "tuned in" to these possibilities, we may not realize the challenges right in front of us until it's too late.
There's been much discussion about "crew resource management" or CRM since the crash. In the old days, the pilot was the absolute captain of the airplane. He (it was almost invariably a man) was the commander in chief, not to be argued with. The result: airplane crashes in which it was very likely that the co-pilot knew they were in trouble but simply was not empowered to say anything.
Much has been learned from those crashes. The culture in the cockpit has changed markedly. Now, not only is it "ok" for the first officer to speak up if he or she senses something wrong, it is an absolute requirement. And the captain is responsible for creating an environment in which people can speak if they have concerns.
These lessons also apply to those of us working in emergency and urgent care settings:
New Articles/Abstracts
Brief summary of recent new articles and abstracts from http://www.PetrackConsulting.com/articles.html
Petrack, E.
This is the first of what will be a quarterly column focusing on the clinical and business aspects of enhancing urgent care services for children and families. This article focuses on why it makes sense to focus on pediatric and family-centered care, and the potential benefits for families and staff.
This important study compares the contribution margin per case per hospital day of ED admissions with non-ED admissions in a single, 600 bed academic hospital with an annual ED census of 100,000. The fiscal years 2003-2005 were examined. For these combined years, there were 51,213 ED and 57,0004 non-ED admissions. The median contribution margin per day was $769 for ED admissions and $595 for non-ED admissions. They conclude that ED admissions generate a higher contribution margin than non-ED admissions.
The authors of this study reviewed the medical literature from 1989-2007 to assess the effects of ED crowding on specific domains of quality, as defined by the Institute of Medicine. Out of 369 articles identified, 41 were reviewed; most of these were observational articles. ED crowding was found to be associated with an increased risk of in-hospital mortality, longer times to treatment for patients with pneumonia or acute pain, and a higher probability of leaving the ED against medical advice or without being seen. They conclude that at least two domains of quality of care, safety and timeliness, are compromised by ED crowding.
This is a retrospective review of ambulance diversions in relation to revenue and profits from one academic medical center from July 2003- December 2006. A total of 166,460 ED patients were included in the analysis. For patients admitted from the ED, average weekly revenues during periods of high diversion were $265K higher than periods of no diversion. The overall increase in profitability was significant for periods of severe divert compared to no divert ($119K per week). The authors conclude that there is no financial disincentive from an inpatient perspective for the boarding of admitted patients in the ED and increasing periods of diversion.
Upcoming Meetings
April 14-16, 2009, American College of Emergency Physicians, Advanced Pediatric Medicine Assembly, Boston, MA 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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