Administration Part 2

1
Administration Part 2

• Sultana Qureshi, PGY-2

2
Outline

• Role of the Medical Director
• Patient Complaints
• Public Relations
• Observation Units

3
(No Transcript)
4
The Emergency Department Director
5

• 80 of the job is just showing up

La Salle. Emerg Med Clin N Am. 2004221-18.
6

• the ED administrative and clinical leader must
  learn how to acquire power of all types

7
Emergency Department DirectorPurpose of the
Position(ACEP Guidelines 1998)

• Provide leadership management for the ED
• Work cooperatively with ED staff to provide
  emergency services to patients
• To work cooperatively with diagnostic and
  therapeutic services to ensure availability,
  quality, and effective use of services
• To provide input into preparation of departmental
  budget
• Monitor community needs and provide input into
  EMS and disaster planning

Aric Storck. Administration 2005
8
Qualifications
ACEP Guidelines 1998

• Career EP with proven clinical and administrative
  skills
• Board certified in EM
• Demonstrated knowledge and ability in financial,
  managerial, and marketing aspects of EM
• Participates in CME
• Demonstrated ability to speak effectively on
  administrative and clinical matters related to EM

9
Responsibilities
ACEP Guidelines 1998

• Leadership, organization, staffing, coordination,
  and evaluation for ED activities
• Ensure ethical practice of EM within dept
• Supervises and has responsibility for EPs in
  clinical and administrative duties
• Acts as liaison between hospital administration
  and ED staff
• Should be member of hospital executive committee
  and represent interests of EM
• Should be concerned with physician scheduling

10
Other responsibilities
ACEP Guidelines 1998

• Department management
• Education
• Liaison
• Public relations
• Recruitment and orientation
• Department meetings
• Committees hospital and departmental

• Quality assurance
• Peer review
• Physician evaluation
• Planning
• Legal
• Risk management
• Contracts and finances

11

• The primary mission of the Emergency Department
  leader is to ensure excellence of professional
  performance at all levels so that safe patient
  care is delivered.

12
What qualities makes a good ED Leader?
13
How does one become a good ED leader?
La Salle. Leadership in Emergency Medicine. Emerg
Clin N Am. 2004221-18.

• 1. Leadership must develop incrementally based on
  trust and credibility.
• 2. Must develop a reputation for honesty, take
  selfless risk, and seek to inspire by example.
  Shoulder a greater burden without complaint.
• 3. Achieve street smarts by developing an
  accurate predictive intuition of what motivates
  action. Careful listening, keen observing,
  understanding their own strengths and weaknesses.
• 4. Good leaders are not selfish understand that
  recognition monetary reward are secondary to
  the goal of providing excellent patient care.
  Take care of their troops.

14
How does one become a good ED leader?
La Salle. Leadership in Emergency Medicine. Emerg
Clin N Am. 2004221-18.

• 5. Understand the ED is not an island, and
  proactively collaborate with outside departments,
  organizations..
• 6. Understand and accept conflict.
• 7. Perseverance to overcome resistance to change.
• 8. Understands the importance of perception and
  works industriously to fashion fair perception
  and promote vision that is realistic and
  attainable.

15
Education

• ACEP Emergency Department Directors Academy
• Four phase course

16
Patient Complaints
17
What do patients complain about?
18
Patient complaint types (CHR-EDs Apr-Oct 2005)
Code Complaint Type
A1.1 Access/Wait Times - Waiting Room
A1.2 Access/Wait Times - Department
A1.3 Access/Wait Times - Other
A2 Financial
A3 Lost Belongings
A4 Physical Environment
A5 Communication Process
A6 Multiple Departments
A7 Triage
A8 Other
B1 Personal Interaction
B2 Care Provided
B3 Other
C1 Personal Interaction
C2 Physician Competence
C3 Discharge Issues
C4 Treatment Expectations
C5 Missed Diagnosis
C6 Other
19
Patient complaint types (CHR-EDs Apr-Oct 2005)

• 1. Treatment expectations
• 2. Personal interaction
• 3. Length of waiting room stay
• 4. Care provided
• 5. Triage

20
Goals of a complaint system

• Facilitate positive interaction with patients,
  public and staff
• Identify systemic problems integrate with QI
  system
• Identify personnel deficiencies (eg poor
  communication skills, staff demeanor,etc.)
• Integrate with overall risk management strategies
  and reduce litigious dispute resolution (ie
  lawyers)

Aric Storck. Admin. 2005
21
Patient Representative Service(CHR Website-
Patient Concerns)

• is a point of entry into the regional health
  system for patients or their advocates to express
  concerns, complaints or messages of thanks
  regarding patient care
• takes a lead role in facilitating the internal
  review process with a focus on client relations,
  information sharing, and conflict resolution
• resolutions based on mutual interests, with the
  goal that this leads to increased consumer
  satisfaction and continuous quality improvement

22
Patient Representative Service(CHR Website-
Patient Concerns)

• Process
• Issues may be brought forward in writing, by
  phone, or online form
• The Patient Representative will assess the issue
  and determine whether a formal review is
  necessary or whether other, more immediate
  measures are required (ie. inpatient vs. remote
  outpatient complaint)
• Concerns received once pt has left hospital- the
  issues are forwarded to the Regional Clinical
  Department Head if a medical review is required,
  or the Director of the service if the issues
  involve staff from the care area
• When messages of thanks are received regarding
  care, the appropriate senior member of the
  service or hospital site writes to the staff to
  commend them and provides a copy of the
  commendation received.

23
Patient Representative Service(CHR Website-
Patient Concerns)

• Time frame
• Many issues can be addressed or resolved by the
  Patient Representative. This is particularly true
  when queries are about regional programs or
  services, policies, processes, etc.
• When a concern is received that requires a formal
  investigation, the goal is to respond back to the
  patient within a 4 week timeframe. (May be longer
  is multiple areas involved, or staff interview
  required.)
• Patient contacted in writing or by telephone.
  (new policies may require only writing. Is this a
  good idea?)
• Patients must provide consent to review records
• Once lawyers involved, becomes CMPA issue

24
Patient Rights(CHR Website- Patient Concerns)

• Be treated with respect and without
  discrimination
• Expect that information about you is
  confidential, and that you will be informed when
  a medical doctor is legally required to disclose
  information for your safety or the safety of
  others
• Expect a medical doctor or health care worker not
  to take physical, emotional, sexual or financial
  advantage of you
• Receive reasonable explanations about your care,
  examinations and treatment so that you may give
  or withhold informed consent
• Personal privacy while disrobing, or when parts
  of your body are being examined
• Refuse a particular type of examination or
  treatment or withdraw consent without obligation
  or harassment

25
Patient Rights(CHR Website- Patient Concerns)

• Be informed of major delays in consultations/treat
  ments, if at all possible
• Know if there are supervisors, consultants,
  students, interns or others with whom your
  medical doctor will discuss your case
• Receive a timely referral or consultation with
  another health professional whenever you and the
  medical doctor believe it appropriate
• Receive a second opinion regarding your treatment
  or the medical doctor's methods
• Be listened to carefully and to receive support
  throughout your health care experience
• Have another person present during examinations.

26
Patient Responsibilities(CHR Website- Patient
Concerns)

• Respect the privacy of other patients, medical
  doctors and staff
• Ask your medical doctor or health care workers
  for further information if you do not understand
  
• Let your medical doctor or health care worker
  know if you feel uncomfortable
• Cooperate and follow the care prescribed as
  recommended for you as long as you are in
  agreement
• Inform the medical doctor or staff if you are
  unable to keep your appointment
• Allow the medical doctor to have a staff member
  present during an examination

27
Key to Avoiding Complaints

• Communication
• Communication
• Communication

28

• Information delivery
• Use anticipatory guidance
• Provide information about diagnoses and potential
  causes of the problem
• Explain results of tests and their implications
• Provide discharge instructions (in writing if
  possible)
• Explain the purpose of procedures and the
  potential for pain
• Tailor the content to the intellectual level,
  medical sophistication, and language mastery of
  the patient
• Foreign language communication
• Acquire proficiency in languages most common to
  the region
• Use professional interpreters

• Expressive quality
• Verbal techniques
• Introduce oneself by name
• Explain ones role in the ED
• Use reflective listening (i.e., summarizing what
  the patient has said to demonstrate
  understanding)
• Use empathetic comments such as I understand or
  I
• see
• Apologize for waits and delays
• Apologize for interruptions
• Nonverbal techniques
• Have good eye contact
• Smile (when appropriate)
• Adopt a concerned and interested look that
  shows you are listening
• Allow the patient to describe their problems
  without interruptions

29
Public Relations
30
Observation Units
31

• The primary objective of observation units is to
  provide an alternative to hospitalization for
  patients requiring extended diagnostic assessment
  or treatment for up to 24 hours
• Advantages include
• Improved resource use (50 less cost than
  admission)
• Increased diagnostic accuracy
• Higher patient satisfaction
• Increased educational and research opportunities

32
3 models of OUs

• The scatter bed model
• any bed in the hospital can become an observation
  bed
• generally does not work very well, because of
  inefficiencies due to the varying needs of
  patients on the floor
• The in-house defined unit model
• usually run by hospitalists within the
  institution
• predominant problem tends to be reimbursement
  issues (mainly US problem with insurance
  companies)
• The linked emergency department model
• a virtual unit, where any bed in the ED can
  become an observation bed
• typically does not work well since the staff is
  too busy with the sickest patients
• Defined Unit
• Technically the ideal model, with unit attached
  to ED.
• Most likely to manage care efficiently

33
What type of patients would you select?
34
Conditions Appropriate for Observation

• Evaluation Critical Diagnostic Syndromes
• Abdominal pain
•  Chest pain
•   DVT
•   Gastrointestinal bleed
•   Syncope
•   Blunt abdominal trauma
•   Blunt chest trauma
•   Penetrating abdominal trauma
•   Penetrating chest trauma
•   Head injury

35
Conditions Appropriate for Observation

• Treatment Emergency Conditions
• Asthma
• Atrial fibrillation
• Congestive heart failure
•   Dehydration
•   Infections
•   Pneumonia
•   Pyelonephritis