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1 June 2015

Strengthening Emergency Department Intake Processes

There are many measures of hospital quality, but two primary dimensions that stand out are patient health outcomes and operational efficiency. Though sometimes they seem to be at odds, the best hospital process improvements tackle these dimensions simultaneously.

Emergency department personnel are uniquely positioned to understand the relationship between patient care and efficiency — they treat both high acuity and high volume patient segments, and they’re largely measured by door-to-provider time and throughput. In the emergency department, improvements to intake and triage systems can have positive impacts on both patient outcomes and the operational efficiency of the department.

Example: Parallel Care Model of Patient Assessment

Slow door-to-provider times are a strong indicator of inefficiency in the ER — and a patient safety risk. Employing Kaizen lean process techniques, Dr. Ken Colaric of Sheridan partner hospital Saint Mary’s Medical Center in Missouri worked with his team to identify areas of inefficiency in their existing triage system. The Kaizen analysis and conversations with all stakeholders resulted in an entirely new “parallel care” model of patient assessment.

The parallel care model encourages emergency department personnel to attend to a patient as soon as they are available, rather than having providers wait for their proper turn in the traditional sequence of emergency care. The department also instituted immediate bedding, so that the patient is ready for a nurse, physician or tech to begin their work as soon as they are available to do so. Registration happens bedside, dramatically cutting down waiting room time.

Saint Mary’s new parallel care model and bedside registration have improved nearly every metric of success for the department. Patients’ average length of stay has been reduced by 30 percent. The “left before being seen” rate dropped a dramatic 88 percent. Door-to-bed and door-to-doctor times have seen significant decreases as well.

In many hospitals, 60-80 percent of inpatient admissions are made in the ER. With the majority of a hospital’s patients experiencing emergency care — and with CMS reimbursement now tied to patient satisfaction — the ER experience has never been more important. Identifying emergency department process improvements that benefit patients’ health outcomes, throughput and, by extension, patient satisfaction, is how hospital leaders can best drive lasting change in their ER.

To learn more about the ways Sheridan Healthcare can help strengthen your emergency department’s processes, read our leadership brief: “The Evolving Emergency Department: Strategies for Staying Ahead of the Curve.”

19 May 2015

Physician Engagement is a Win, Win, Win

The term “physician engagement” is ubiquitous in today’s healthcare conversation, and it is often prescribed as the solution to a number of hospital management issues. But what does it really mean, and why is it so beneficial?

Achieving Engagement

To be engaged means “to be greatly interested or committed.” Physician engagement centers on a physician’s commitment to enhancing the performance of the organization by continuing to develop their own clinical and managerial skills, as well as those of their teammates.

When physicians are engaged, they are actively involved in their organizations – they go beyond treating their patients and performing the accompanying administrative duties. Engaged physicians participate in and lead education courses; they also serve on boards and committees within or on behalf of their organization. They dedicate their time and effort to the larger goals of the hospital or health system, beyond their immediate goals as individual physicians.

There is much discussion about how hospital leaders can achieve physician engagement. At its core, the process is similar to creating a successful business relationship: hospital leaders must establish mutual trust, empower physicians to voice their opinions, involve physicians in crucial decision-making processes, and ensure they have the access to the resources they need.

Benefits of Engaged Physicians

The benefit to having engaged physicians is three-fold: happier physicians, healthier patients and a better performing hospital.

Not only do physicians themselves benefit from being engaged, but so do their patients. Engaged physicians demonstrate a deeper commitment to improving their own performance. One important aspect of a physician’s performance is demonstrating empathy. Patients with empathetic physicians are more likely to confide personal details that may help in diagnoses, and are more willing to adhere to treatments that improve their health. Recent studies have shown that a positive doctor-patient relationship can actually improve outcomes for patients with obesity, diabetes and asthma. Additionally, patients of engaged, empathetic physicians are more likely to be satisfied with the care they have received.

With more hospital reimbursement tied to patient satisfaction and health outcomes, hospitals will benefit enormously from an engaged physician group and the improved patient outcomes that come along with it. Not only are patients happier and healthier, but when physicians are engaged, they think about the goals of the organization at large. Therefore, change management and process improvement initiatives have a higher likelihood of succeeding in hospitals with engaged physicians.

Physician engagement may indeed be one key to hospital performance improvement on a number of different levels. It is important to spend time thinking about what engagement really means before developing a strategy to cultivate it.

To learn more about how hospitals can engage physicians and align the goals of the organization and the individual, check out our white paper: Advancing Hospital-Physician Collaboration with a Clinical and Management Services Organization.

24 April 2015

Joe DiMaggio Children’s Hospital Institutes “Tutu Tuesday”

Thorough audits that involve all staff equally are the best way to improve hospital processes. But while these rigorous process improvement frameworks are at the core of what we do, we also realize that good ideas often come from less structured origins.

One of our partner hospitals, Joe DiMaggio Children's in Hollywood, Fla., reminded us of this when they instituted “Tutu Tuesday.” Joe DiMaggio has a long history of innovation in pediatric surgical care, especially when it comes to patients with autism – but Tutu Tuesday is a little different.

In contrast to their rigorous and well-documented autism procedures, the creation of Tutu Tuesday was a bit more serendipitous. It all started when operating room assistant Tony Smith wanted to make one of his pediatric patients a little less nervous before surgery. To make the preoperative process more light-hearted, Tony decided he'd put on a multi-colored tutu over his scrubs.

The patient loved it, and that simple, silly idea ended up going a long way to improve his experience. Smith never imagined that this small gesture would end up spreading through the department and improving dozens of patients' surgeries – and he certainly didn't foresee that it would catch the attention of the national news media, including ABC News, NBC TODAY and dozens more.

Tutu Tuesday teaches us that, sometimes, process improvements that improve patient experience can come from the most unexpected places – and are almost always a little unorthodox. As Smith told ABC News: “Seeing you in a tutu brightens [patients'] day, and it can keep them from thinking about what's really going on.”

10 April 2015

Blood Management Programs Help Improve Quality and Reduce Costs

Blood transfusions are among the most common medical procedures at US hospitals. In this case, however, more is not always better.

The Need for Blood Management

Blood transfusions are often necessary lifesaving procedures, but hospitals must be careful of overusing transfusions when unnecessary. The inefficient use of blood transfusions is both risky and wasteful. Transfusions bring higher risks of mortality and other dangerous complications. They are also costly. The direct cost of one unit of red blood cells is $200 on average, but there are numerous supplemental costs such as the transportation, testing, inventory management and storage of the blood. A 2010 study published by Transfusion, a peer-reviewed academic journal, estimated that blood transfusion costs actually range from $522 to $1,183 per unit of blood. Additionally, transfusions can impact the length of stay for a patient if infections or complications occur, driving costs up further. If a hospital is not careful in its management of blood transfusions, it can rack up hundreds of thousands of dollars per year of unnecessary added costs.

Characteristics of Effective Blood Management Programs

In today’s value-based, cost-sensitive healthcare market, an effective blood management program can help hospitals lower costs and improve quality of care.

The first component of these programs is the establishment of standardized guidelines that help doctors determine whether a transfusion is necessary or avoidable. National blood transfusion protocols do not exist, so hospitals are responsible for developing and propagating their own guidelines. Necessary guidelines include developing a standard order to transfuse, mandating that transfusion orders be required and documented during all surgeries, setting acceptable pre-transfusion blood lab values and creating a consistent informed consent process for patients that may encounter a transfusion.

Once hospital-wide transfusion guidelines are defined and implemented, applying some of the blood management strategies recommended by the Society of Cardiovascular Anesthesiologists (SCA) and Society of Thoracic Surgeons (STS) can help build out a comprehensive multimodal blood conservation program. Some of those strategies include:

  • Working with cardiologists before surgery to make sure the patient is not on unnecessary doses of blood thinners and to ensure anemic patients have the proper pre-op medicine
  • Carefully rationing IV fluids so the patient’s blood concentration does not drop unnecessarily during surgery
  • Drawing a unit of blood from the patient the day of surgery, in case it is needed
  • Reducing the amount of plumbing in the heart/lung machines so that they use less blood-diluting fluids
  • Standardizing the way anti-bleeding medications are given during surgery

Education is also a critical component of an effective blood management program. Hospital staff need to be fully informed about the risks, benefits and alternatives to transfusions. Education helps doctors and staff achieve a patient-centered decision making model that is integral to quality improvement.

Example of a Successful Blood Management Program

A Sheridan anesthesiologist, Dr. Robert Brooker, initiated a blood conservation program to improve the transfusion rates at Memorial Regional Hospital in South Florida. The hospital started following an established protocol in 2008 and conducted a five-year study of the results of more than 1,000 patients. Over the span of those five years, Memorial Regional Hospital was able to:

  • Reduce surgical transfusions in cardiac patients by 68%
  • Reduce the amount of blood needed by 80%, saving the hospital $715.14 per unit
  • Reduce the number of heart surgery-related deaths, infections, strokes and re-operations by 50%
  • Reduce infections by 100%

These reductions have helped earn Memorial Regional Hospital its current 3-star rating from the Society of Thoracic Surgeons (STS), the highest rating awarded by the organization.

Conclusion

Transfusions will always be necessary on some level. A blood management program is not aimed to reduce these procedures across the board, but rather to target where transfusions may be unnecessary and might actually be putting patients at risk. As Dr. Brooker explained, “Blood transfusions in heart surgery, or anywhere, are only good for you if you really need it.”

26 March 2015

Aligning the Board Room and the Operating Room

At its core, leadership is about helping a group of people with diverse skillsets and perspectives work together effectively. Generally, a team with a broader collective skillset is able to produce more valuable products and services than a more homogenous team. However, the realization of that added value almost always hinges on a leader’s ability to focus the team members’ diverse perspectives on a common goal. The more divergent perspectives a leader can align, the more value he or she can create; put simply, more difficult challenges yield greater rewards.

This concept was highlighted in a recent piece in the New York Times’ The Upshot column, titled “In Hospitals, Board Rooms Are as Important as Operating Rooms.” In the article, health economist and researcher Austin Frakt makes the case that the most significant hospital process improvements won’t come from a clinical team alone; instead, they develop by aligning the goals of the clinical and business leaders within a hospital. As the primary intersection between clinical leaders and the board of directors, CEOs and other senior leaders are uniquely positioned to bring about that alignment.

For obvious reasons, this is easier said than done. Besides the overall success of the hospital, clinical leaders and board members have few priorities in common. Boards, for the most part, are primarily interested in the facility’s financial health, and many members have little experience with the intricacies of the healthcare industry. Clinical leaders, on the other hand, are focused on the efficiency of the departments they oversee and the care and satisfaction of their patients. These issues are two sides of the same coin – an insolvent facility can’t function, and the link between reimbursement and patient satisfaction means quality of care directly affects the bottom line. The hallmark of a good leader is the ability to bridge this gap.

This means improving communication between the two teams, and – as the New York Times article makes clear – one of the best ways to do so is by borrowing management practices from the manufacturing and technology sectors. One of their most successful management practices is Kaizen, which Sheridan Healthcare has been helping hospital leaders implement for decades. Kaizen is particularly useful for improving communication between parties with different perspectives. As the article puts it:

“These management practices include eliminating inefficiencies and variations, fostering collaboration, setting targets and tracking progress toward them.“

Kaizen encourages a continuous stream of feedback from all stakeholders in a particular process. It helps eliminate waste from a process while ensuring the resulting improved process meets the needs and goals of everyone involved. The Times article highlights instances of Kaizen and other “lean” management techniques

reduc[ing] the time it takes between when a heart attack patient arrives at a hospital and when he’s treated, improving outcomes. Other work found good management is associated with better quality of care in intensive care units.”

Through a management technique like Kaizen, hospital CEOs and other leaders can facilitate the creation of streamlined hospital processes that meet the goals of physicians and other care providers, as well as the C-suite and board. This alignment of diverse skillsets and perspectives drives clinical, financial and organizational improvements for a hospital, simultaneously.

To learn more about Kaizen and how it’s been successfully implemented in the past, watch our video here.

26 February 2015

Improving Patient Care Through Efficient Processes

In many hospital systems, quality improvement efforts focus primarily on an outcome rather than the process that produces it. This may make sense intuitively, but experience has shown it to be the wrong strategy: in the vast majority of cases, small investments in process improvement can lead to outsize improvements in the final product.

This concept was highlighted in a recent FierceHealthcare guest post by Dr. Tom Scaletta, the Medical Director of Emergency Services at Edward Healthcare in Naperville, Illinois. In the article, Dr. Scaletta explains how a seemingly minor change to his organization’s patient follow-up processes – contacting patients immediately after discharge rather than with a mailer several days later – translated into significant improvements in patient outcomes and patient satisfaction scores. By contacting patients immediately after discharge, the hospital improved their survey response rate significantly and generated hundreds of “valuable real-time opportunities to improve patient care, reduce readmissions and understand important patient perceptions.”

Although they often sound simple, process improvements can be surprisingly difficult to implement. This is because designing and implementing improved processes requires critical thinking from the entire team, deep understanding how the current process works and buy-in from all affected employees. Overcoming these challenges and unlocking this potential for improvement is a critical function of the modern healthcare executive.

Process Improvement Systems

C-level hospital executives can’t be personally involved in driving improvement in every one of their organization’s processes – there’s simply too much to do. Instead, the executive’s role should be establishing systems that encourage process improvement and building a culture that helps employees find and implement them. This is, arguably, a much more difficult task than simply implementing, but the results are certainly worth it. Achieving the types of process improvements detailed in Dr. Scaletta’s article is much easier when such a system is in place.

Fortunately, management frameworks exist that can help healthcare organizations achieve this goal. One such is Kaizen, a methodology for continuous process improvement that was most famously implemented by Toyota. Kaizen is a powerful framework that helps employees improve and standardize processes, and it excels in clinical settings. The Kaizen approach works especially well with multi-disciplinary teams and allows for rapid implementation of new processes. Furthermore, it encourages a culture of continuous improvement as staff are encouraged to provide feedback through the entirety of a process – before, during, and after its implementation. In a nutshell, Kaizen makes processes more reliable and less wasteful while simultaneously encouraging meaningful employee involvement.

Implementation Challenges

While implementing a new process is hard in any organization, those in the healthcare industry know it is particularly challenging in a clinical setting. Buy-in, particularly among physicians and nurses, is tough to get, yet critical to success. Convening – let alone assigning importance to – opinions is equally challenging, and the energy to carry out the new process can wane over time. But such measures are necessary to develop and implement a process that works for patients and the systems in which they are treated.

As healthcare organizations look to improve processes facility-wide, it’s critical to remember the importance of a solid process improvement framework such as Kaizen. In addition to improving culture, these frameworks have been shown deliver a remarkable return on investment for the organizations that implement them. As the healthcare landscape continues to change – be it towards patient-focused care or another front – process improvement frameworks will help ensure that the industry evolves with it.

To learn more about how the Kaizen approach can improve hospital processes, visit our resource center.

24 February 2015

Combating Concussions

Evidence of the potentially life-threatening consequences of severe head injuries is growing, and recent lawsuits have thrust sports-related head injuries in particular into the national spotlight. Ray Easterling filed the first lawsuit against the National Football League in 2011, but Easterling committed suicide before the trial ended. He was posthumously diagnosed with chronic traumatic encephalopathy (CTE), a progressively degenerative disease that develops as a result of multiple concussions or traumatic brain injuries (TBI). Since that first lawsuit, the National Football League has agreed to pay out more than $765 million in settlement money to its 18,000 retired players because of concussion-related brain injuries.

This dramatic increase in high profile CTE cases has drawn significant interest in the medical research community, and one of the most prominent research supporters has been retired Jets quarterback Joe Namath. According to Namath, he sustained his fair share of concussions during his 13 seasons in the NFL, and he had recently begun experiencing fatigue and decreased cognition. His concern peaked in 2012 when he learned that star linebacker Junior Seau’s highly-publicized suicide may have been caused by CTE. As part of his treatment, Namath started undergoing hyperbaric oxygen therapy, a relatively new therapy recommended by his friend Dr. Lee Fox, a radiology medical director with Sheridan Healthcare. The treatment involves breathing 100 percent pure oxygen (compared to the 21 percent oxygen in the air that we normally breathe) for an hour or more while lying in a pressurized chamber. Originally conceived as a way to help deep sea divers recover from decompression sickness, the treatment has become increasingly popular in treating a number of diseases. Oxygen therapy helps stimulate the growth of new blood vessels, which can be critical to recovering from blood loss in the brain caused by a violent blow to the head.

The benefits of hyperbaric oxygen therapy have yet to be demonstrated in a formal clinical study, but Dr. Fox – along with his colleague Dr. Barry Miskin, chief of surgery at Jupiter Medical Center – are looking to change that. After seeing improvements in Joe Namath’s cognition and memory functions as a result of his continued hyperbaric oxygen therapy, they decided to test their results further. Working with Sheridan, they developed a groundbreaking protocol for the use of hyperbaric oxygen therapy for TBI and recently received approval from the FDA to launch the therapy’s first clinical trial.

Namath himself has pledged $10 million in support of the trial and the work that Dr. Fox and Dr. Miskin are doing. “Having Joe’s support is a huge boon to both the financial needs of the research and to the visibility of our work,” said Dr. Fox. “We hope his support will lead to a successful outcome for our study and more research in the area of TBI.” The trio’s pioneering efforts have led to the creation of the Joe Namath Neurological Research Center at the Jupiter Medical Center in Florida, which is supported by Sheridan’s clinical research and innovation programs.

To learn more about how Sheridan helps hospitals develop innovative physician teams, please visit our resource center.

To learn more about the clinical trial, visit www.namathneurocenter.com

28 January 2015

Emergency Department Burnout: The Right Leaders with the Right Tools

More than 50 percent of ED doctors suffer from burnout at some point in their career. Burnout is particularly acute in this specialty: emergency medicine and critical care specialists suffer burnout at a 16 percent higher rate than the next highest specialty (family medicine), according to a 2013 Medscape Medical News study. The problem is made even more difficult by the widespread labor shortage in the emergency medicine market, which is expected to last for at least the next few decades.

In the face of these challenges, how can hospitals maintain a stable ED team and ultimately deliver better patient outcomes and experiences? While there is no silver bullet to solve this problem, one option is to provide ED physicians with resources that help them perform more efficiently and – in some cases – even report higher job satisfaction.

ED Physician Tools and Resources

Sheridan’s ED Physician Portal provides resources to address some of the concurrent issues that lead to burnout. The stressors that cause physician burnout can be sorted into two primary types: practical and emotional. Practical stressors are clear steps in a process that lead to dissatisfaction. The Medscape study lists several of them in its top 10 causes of burnout: “Too many bureaucratic tasks,” “Too many hours at work,” and “Income not high enough.” Emotional stressors are oftentimes vague and are usually more about empowering the individual than changing an ED process. Medscape lists “Feeling like just a cog in the wheel” as their #3 cause of burnout, for example.

Sheridan Emergency Medicine offers several resources to address both stressor types and can help the broader organization identify the best ways to serve its emergency medicine physicians:

  • The Emergency Medicine Practice Support Team link connects Sheridan’s local ED physicians to Sheridan’s national Emergency Medicine Leadership and Support Service teams, which includes Sheridan’s Kaizen, Operations and Clinical Quality teams. Sheridan’s Clinical and Operations leadership teams are always accessible to provide guidance and support to our Clinical Chiefs and clinicians. Likewise, the Suggestion Box allows ED physicians to air their concerns and be sure that Sheridan’s Emergency Medicine Leadership will see them.
  • Sheridan’s Leadership Development Program enables leaders at all levels to grow and enhance their ability to elevate the overall performance of their departments. Educational resources are made available, including programs from The Sullivan Group on risk mitigation, as well as premier education websites and audio series for emergency physicians.
  • ClearPATh ED helps ED physicians execute on efficiency and throughput. This lean workflow streamlines the patient experience and ensures the timely, appropriate evaluation of ED patients.

Preventing burnout among ED staff will be one of the greatest challenges facing hospitals over the next few decades. While a physician portal is by no means a complete solution for burnout, it does offer features that can provide critical support to a much larger physician satisfaction strategy.

21 January 2015

Sheridan Pioneers Anesthesia Care for Pediatric Patients with Autism

Guest post by Dr. Sandra Kaufmann, Chief of Pediatric Anesthesia, Chief of Pediatric Pain, Joe DiMaggio Children's Hospital

According to the CDC, around 1 in 68 American children are affected by autism spectrum disorder — representing a ten-fold increase in prevalence over the last 40 years. It is not surprising that these children, on occasion, will require anesthesia for various procedures and examinations. At Joe DiMaggio Children’s Hospital we have gained extensive experience over the years caring for autistic children, and have developed methodologies that address both the behavioral and metabolic issues that are associated with this disorder. The perioperative needs of a child with autism differ in almost every way from the traditional processes, and our hospital is committed to pioneering procedures and practices that best serve this growing subset of patients.

Preoperative Strategies

At the very onset, we understand that children with autism are challenged by new surroundings and a change in their routines and life patterns. We try to minimize their fears as much as possible by mirroring their routines where possible and trying to make their hospital visit as brief as it reasonably can be. Our autistic patients are usually the first case on the operating room’s schedule to reduce any waiting time. All rooms in the pre-operative area are private and quiet, where the family can stay with the patient. We also have a team of child life specialists, as well as in-house therapy dogs, who are available to provide comfort and entertainment.

Autism Friendly Medical Regime

Choices of medications for autistic patients are determined by their clinical presentations, any concomitant medical issues and the degree of sedation required. We have devised our own Autism Friendly Regime to minimize any ill effects while optimizing the operative experience. This regime begins with an oral medication to reduce stress, calm the patient and provide a degree of amnesia. If necessary, with the assistance of the caretaker, we camouflage this medication in whatever drink the patient is familiar with to make the first step as easy as possible. If the patient refuses the oral medication, we work closely with the family to devise an alternative plan.

Customized Anesthesia Plan

Family apprehensions about the anesthesia plan usually revolve around two issues. The first concerns the intraoperative medications. We make every attempt to avoid polypharmacy, which has been found to be problematic in these children. Specific medications thought to be detrimental to children with associated mitochondrial disorders are clearly avoided. The second concern is always the IV. This is placed once the child is asleep, and it is extremely well secured. It is also removed earlier than usual in the recovery room to minimize undue anxiety.

In essence, the anesthesia team at Joe DiMaggio is very conscious of the fact that our autistic patients require special care. Every child is different, and our flexibility and creativity are the cornerstones of ensuring that all of our patients receive the best treatment possible.

16 January 2015

Emergency Medicine’s Changing Role

In today’s healthcare landscape, it could be argued that “emergency department” is a misnomer for the typical ED. Emergencies happen, but the majority of patients come into the emergency department for more minor issues, or even just to be admitted to a department deeper within the hospital. In many hospitals, 60-80 percent of admitted patients come in through the emergency room, compared to 30-50 percent in decades past. Since more people are using this place as the point of entry to a hospital, patient satisfaction scores—and thus revenue—will increasingly depend on the patient experience in the emergency department.

Reasons for Emergency Medicine’s Changing Role

Though busy emergency rooms are often attributed to a large population of uninsured patients, a shift in how patients are diagnosed is also a contributing factor. Diagnostic technology has improved tremendously over the past few decades, and this quality improvement has been accompanied by increased cost. These costs are primarily a concern for Primary Care Physicians (PCPs): in cases where diagnostic tools are relatively cheap and low-tech, a private PCP can perform many of the same diagnostic procedures as the staff within the emergency department with a minimal investment in tools and instruments. But in cases where more expensive diagnostic devices are necessary – an MRI scanner, for example – achieving the same diagnostic sensitivity as an emergency department is cost prohibitive for PCPs. In effect, increased instrument costs have made it impossible for PCPs to achieve the sensitivity necessary to provide maximally accurate and legally defensible diagnoses for patients that present with certain symptoms.

Emergency departments, which have much more diagnostic and financial resources than private PCPs, have picked up the slack. Many now function as a sort of “rapid diagnosis and treatment center” – they serve, for all intents and purposes, as the general intake department for their hospital. The significant uninsured population, in concert with the continuing advancement of diagnostic technology, ensures that this trend will continue for years to come.

Prioritizing Patient Experience

The emergency department has become the starting point for diagnosis and care for emergency and non-critical patients alike. It has also become a patient’s first impression of his or her hospital experience. As Dr. Richard Petrik of Sheridan partner Ocala Regional Medical Center puts it: “If patients don’t have a good experience in the ER, they’re primed not to have a good experience on the inpatient side.”

The obvious metric influencing a patient’s experience in the emergency room is wait time. As patient volume increases, hospitals should evaluate their processes to identify any opportunities to cut down on door-to-provider times. Another area with room for improvement, says Dr. Petrik, is the communication between PCPs and ED physicians. As more primary care doctors send patients to the emergency room for further testing and evaluation, Dr. Petrik explains, a patient’s quality of care and time spent here can be greatly improved if the PCPs effectively communicate what they have learned in their initial meeting with a patient and what they had in mind when sending the patient to the emergency room. Better communication facilitates better care and ensures that a patient’s time isn’t wasted while emergency medicine physicians collect the same information the PCP already gleaned.

Small process changes can make a big difference in the patient experience, and increased patient volume means that these small improvements can quickly snowball into large benefits. As long as the emergency department continues to act as the “front door of the hospital,” making these shifts to better the patient experience will be of critical importance.