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 Spring 2011 Volume 9, 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! CalmerKids is now used to upgrade pediatric care in more than 60 emergency departments and urgent care centers around the country. Get a new low price, plus become CalmerKids Certified when training is complete. Show me...
NOTE: We will be taking a break from Spotlight on Emergency Care this summer, and will return with the next issue in October, 2011. |
Consultant's Corner Emory Petrack, MD, FAAP, FACEP
As I was driving into work one day, I heard a story on NPR about John Kralik, a down-on-his-luck lawyer who decided to write one thank-you note each day for the next year, or 365 thank-you notes. (Kralik has since turned this experience into a book entitled "365 Thank Yous.")
Feature Article
At first, he thought is was a complaint...
Those of us who work in emergency or urgent care settings are used to the hectic pace of—and the attendant problems and challenges that arise from—caring for sick people in often less than optimal conditions. And those of us who work in leadership positions are used to "handling" the various complaints that come across our collective desks. Of course, while complaints can be difficult, they are often a "window" into legitimate concerns and areas where we can improve.
But that is not the subject of this article.
Instead, the subject is our human tendency to focus on problems and complaints. While it is important to address concerns and issues, it is also important not to become so caught up in what is not working well that we fail to see the "good" before our eyes. A long-term "problem-hunting" mindset can be very demoralizing for staff and leadership alike.
Here, I offer two suggestions to help you counteract our natural tendency to focus on problems and complaints.
First, as the gentleman in the NPR story did, be more aware of and grateful for the positive people and events that surround you. If we open our eyes and ears to everything going on in our environments, we will undoubtedly discover events, stories and happenings that bring out the best in us and those we work with. Articulating the "good" we see, and giving thanks and praise when appropriate, will go a long way towards enabling us to have those more challenging conversations about complaints and problems that will ultimately arise.
Second, consider using the "appreciative inquiry" methodology to get at the problems in your department or center. At the heart of this methodology is a focus on what works well, as opposed to the usual focus on problems. By understanding the common threads of what is perceived to be working well in a department or organization, you can better address problems and challenges in a more positive and productive fashion.
While a full discussion of appreciative inquiry is beyond the scope of this brief piece, the following summary can get you started:
New Articles/Abstracts
Brief summary of recent new articles and abstracts from http://www.PetrackConsulting.com/articles.html
Rowe, B. H., Guo, X., Villa-Roel, C. et al.
As EDs work to reduce throughput times, one effort has centered on having physicians help with the triage process. This study examined the effectiveness of triage liaison physicians (TLPs) on ED overcrowding by reviewing 28 studies in a systematic review. Although the summarized evidence suggests that having a TLP is effective in mitigating the effects of overcrowding, most of the studies were noted to have problems with methodology. They suggest that more research is required prior to widespread implementation.
This was a qualitative studies of EDs in England, where there is a requirement that 98% of patients treated must be discharged or placed in a hospital bed within 4 hours of arrival. The goal was to discern what can be learned through the process of implementing this requirement. Learnings included a need for widespread trust to support the interdependency required for success, collaborative strategies, and focus on patient safety while achieving throughput time goals. There are definite lessons here related to challenges surrounding collaboration that can be applied to achieving hospital wide goals in other settings.
Triage standing orders are another strategy used in many EDs to help reduce throughput times. This was a retrospective study in one academic ED, looking at the effect of standing orders for chest pain, shortness of breath, abdominal pain, or genitourinary complaints. Of 15,188 eligible patients, 25% received full triage standing orders, 56% partial standing orders, and 19% room orders. Overall, triage standing orders were associated with a 16% reduction in median treatment time, regardless of chief complaint.
Upcoming Meetings
April 11-13, 2011, American College of Emergency Physicians, Advanced Pediatric Emergency Medicine Assembly, San Diego, CA.
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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