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The Problem: How to combat declining pediatric volume in a county-wide hospital system due to the establishment of a new, "family friendly" emergency department in a nearby city
The Lake Hospital System, which has served Lake County Ohio for years and includes two campuses with two emergency departments, faced increased competition for pediatric patients and noticed declining pediatric volume when a full pediatric emergency department was established in a nearby city. Senior hospital administration, wishing to enhance its pediatric focus, contacted Petrack Consulting.
The Solution: Petrack Consulting worked with senior hospital administration, emergency department leadership and ED staff to address the issues of increased competition and volume decreases. After conducting a gap analysis and interviews with both internal staff and community referring physicians, Dr. Petrack identified numerous factors impeding the establishment of both the reality and perception of Lake Hospital as an excellent community provider of child and family emergency care. One of those factors included the decisions of referring physicians to send or not send patients to either of Lake Hospital's campuses.
Through several sessions with physicians, nursing staff and medics, Dr. Petrack brought the institution up-to-speed on current best practices in pediatric emergency care and medical legal risk reduction. Also, after a detailed review of approximately 100 ED patient charts, Dr. Petrack met with ED leadership to explore ways in which both medical quality and family satisfaction could be enhanced.
The Result: At the end of the engagement, Lake Hospital System leadership had a decisive, relevant roadmap and timetable for implementing the needed changes, as well as a plan for a new pediatric quality improvement program. The ED leadership team is now working to implement Dr. Petrack's recommendations, with the expectation that Lake Hospital will soon be seen once again as a great place to go for community pediatric emergency care.
The Problem: How to quickly increase declining pediatric volume in a highly competitive market
St. John West Shore, located in Northeast Ohio's highly competitive pediatric and emergency services market, was experiencing decreasing volume in its pediatric RapidCare area.
The Solution: Petrack Consulting was asked to develop a cost-effective plan for rapidly enhancing pediatric services to increase pediatric emergency volume. To integrate a new pediatric care vision into the hospital's current emergency services strategy, Dr. Petrack participated in strategic planning with hospital and physician leadership and interviewed several community practitioners to gain insight into their perspectives of pediatric care at St. John West Shore. During planning, Dr. Petrack analyzed both emergency and inpatient pediatric services and provided options for facility improvements that would enhance family satisfaction. As a result of this work, Dr. Petrack and hospital leadership collaboratively developed a plan to improve the integration and efficiency of pediatric services.
The Result: Based on the recommendations of Petrack Consulting, St. John West Shore is introducing a new pediatric team to improve the coordination of services. Hospital leadership is also implementing several recommendations for physical facility enhancements, including an improved family focus and an integration of physical space for families into the emergency department. Based on input from community providers, St. John West Shore also updated patient care processes. And because community providers appreciated the opportunity to participate in the improvement process, the hospital also anticipates more consistent provider referrals.
The Problem: Establishing and Staffing a New Pediatric ED...Within One Month
Emergency Physician Services (EPS), Fairview Hospital's emergency services provider, needed to establish and staff a new pediatric emergency center immediately. EPS contacted Petrack Consulting to make sure the project went smoothly and the opening could proceed as planned.
The Solution: On behalf of EPS, Petrack Consulting worked closely with Fairview leadership to complete a gap analysis so all parties involved would know exactly what had to be done to meet the one month deadline. The firm also developed policies and procedures and a quality improvement initiative, tackled space concerns and discussed the new ED's marketing strategy. Working with a recruiter, Petrack Consulting is currently seeking a Pediatric ED Director and other staff trained in pediatric emergency medicine for the new ED.
The Result: The new pediatric ED opened on time. A child-life specialist works in the ED during the busy afternoon and evening hours, and turnaround averages about an hour. More importantly, families are happy; many have offered positive feedback about Fairview's new pediatric ED.
The Problem: How to Help Staff at an Adult-Focused Community Hospital Provide Better Care to Pediatric Patients
St. Elizabeth Health Center is a community ED that sees only a moderate amount of young patients. But that didn't stop hospital leadership from wanting to improve their pediatric emergency care for children.
The Solution: Petrack Consulting came in to evaluate existing care and provide ideas for reaching that goal. Based on the firm's work, St. Elizabeth's:
- Identified a pediatric clinical coordinator who serves as a resource for the department and develops educational programs for staff
- Developed carepaths on asthma, bronchiolitis, fever and seizures
- Provided interactive training sessions for staff and physicians
- Evaluated ED drugs and equipment for pediatric appropriateness
The Result: St. Elizabeth's is now equipped to handle pediatric emergencies and is on its way to becoming a pediatric center of excellence. Staff reports they feel much more prepared and comfortable since they don't see pediatric emergencies often.
The Problem: "Stretched-to-the-Breaking Point" Tension between ED and Clinical Consultation Service
Varying personality and leadership styles typically lead to tension; individuals at hospital emergency departments are no exception. In this case, staff members from various departments at Charleston Area Medical Center were unable to resolve differences, leading to a tense, stressful environment.
The Solution: Petrack Consulting stepped in as an objective third party to help hospital and ED administration clear the air by improving communication and delineating roles and expectations of the various consulting services, as well as by strengthening ED physician and nursing leadership skills. While there, Petrack Consulting also noticed the ED lacked a quality improvement plan and had no system in place to handle sudden spikes in ED volume. To rectify this, the firm developed policies and procedures, improved triage processes and developed a fast track area for pediatric emergency care.
The Result: Today at Charleston Area Medical Center, emergency department physicians and clinical consultation services enjoy better working relationships-resulting in less on the job stress and a healthier, more productive work environment. ED physician and nursing leadership work smoothly together to provide consistent direction for the department. And, the Center's pediatric patients also benefit from a clear delineation of the triage process and the establishment of a fast track area.
The Problem: Establishing a Series of Pediatric Fast Track Centers for System Hospitals While Obtaining Buy-In from Local Primary Care Providers
University Hospitals Health System in Cleveland wanted to establish a series of pediatric fast track operations at various system hospitals. In addition to the challenges of such a venture in and of itself, hospital leadership had to help local primary care providers understand the process of establishing the centers, and assure them the centers would not mean less business for their practices.
The Solution: As Director of Pediatric Emergency Care at Rainbow Babies and Children's Hospital, Dr. Petrack worked with hospital leadership to raise grassroots support and involvement from local providers. Starting the programs from the ground up, Dr. Petrack met staffing challenges, developed policies and procedures and a quality improvement program, and provided marketing assistance to the new centers.
The Result: From 1995 to 1999, University Hospitals Health System developed its own pediatric fast track area, as well as welcoming "Rainbow RapidCare" fast track centers at the following system entities: Southwest General, St. John West Shore, Mercy Medical Center and Chagrin Highlands. Each of these centers prides itself on delivering strong family satisfaction and excellent pediatric focused minor care.
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Emory Petrack, MD, FAAP, FACEP
Petrack Consulting, Inc. ~ 16781 Chagrin Blvd., #249 ~ Shaker Heights, OH 44120
Phone: 216-371-8755 ~ Fax: 216-928-9400
Email: epetrack@PetrackConsulting.com
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