When Both Luck and Being Good Run Out on You…Thoughts on Clinical Peer Review in Medicine

Christopher Beach, MD, FACEP
ChairProviding emergency care at the highest level day-in and day-out is challenging.  Some days we really do feel that, “it is better to be lucky than good.”  There are innumerable nuances to the dance steps we go through, enough to drive a choreographer insane. [ For instance, this PMD wants this type of consultant, this doctor likes this hospitalist service, this specialist always wants an MRI, someone wants to be called at all hours/someone doesn’t want to ever be called, and on and on.]  Some days, even your best is not enough to keep step with the tune.  And, when both luck and being good run out on you, inevitably there is a letter in your inbox from the Clinical Peer Review department asking for information about the care you provided to a patient.

Electronic Health Records Blues

Ralph Badanowski, MD, FACEP
Donald Kamens, MD, FACEP, FAAEM

Upon reviewing even just a few of the thousands of review articles on the Electronic Health Record (EHR), it is quite reasonable to conclude that most clinicians would prefer paper.  Why?  [The details are many, but the overall impression one gets is that providers do not really see value in performing tasks that are predominately secretarial, especially when their already overstretched time could be more effectively spent on actual clinical matters, like communicating with patients and staff, decision making, case consideration, addressing safety and risk for their patients, and real-time research.]

A pilot study from McKinney Community Health Paramedicine program and BEST EMS

*Adapted from a piece appearing in EMNews October 2010
Could Fire Based Advanced Practice Paramedic home visits decrease the frequent 911 calls/hospital readmissions in patients with stable chronic diseases; while also increasing In-Service time for fire apparatus?-----A pilot study from McKinney Community Health Paramedicine program and BEST EMS.

Liz Fagan MD, Hao Wang MD, Larry Bean MD, Dan Frey FF-APP, Brian Roether FF-APP, Chris Waller FF-APP, Fire Chief Danny Kistner, Operations Chief Tim Mock, EMS Chief Jason Hockett
With special thanks to:  Robert Leavitt FF-APP, JC Stinson FF-APP, McKinney City Manager Jason Gray, Sharon Malone MD, Tim Hartman MD, the Case Managements department, and The Entire McKinney Fire Department

Goals/Vision
Our goal is to enhance the health of the McKinney Community/Align with Institute for Healthcare Improvements Triple AIM, while providing a cost savings to the fire department, city of McKinney and local hospitals.  We hope to accomplish this by reducing non-emergent 911 calls while simultaneously reducing the need for 911 calls in the high utilizers group (HUG).  This should be reflected in unnecessary fire engine/fire truck calls and cost as they are disregarded when the squad takes the calls for them accompanying the MICU on medical 911 calls.

The Future of Emergency Medicine Part I

David Meyers, MD, FACEPOn December 4, 2013, the respected journal Health Affairs sponsored a conference on “The Future of Emergency Medicine”, the theme of the December 2013 issue of the publication. Founded by John K. Iglehart in 1981, Health Affairs is an influential thought leader among America’s health policy resources.  Speakers at the conference, many well-known to us in QIPS and ACEP, were all contributors to that issue of Health Affairs and addressed different aspects of our emergency health care system.  What follows is my sense of the highlights of the conference.  Full audio and video links to the program are available online.

Editor's Note

Jeff Pothof, MD, FACEP
Newsletter EditorThis edition of the QIPS Newsletter is full of interesting reads and tips.  I hope you find the time to browse through the different articles. Our Chair, Christopher Beach, MD, FACEP, provides a nice perspective on the history of physician peer review and how it has evolved over many years.  If you think hand washing is only a problem we have today then you owe it to yourself to read this article.

QIPS Tips

Shari Welch, MD, FACEP Smile for the Camera: HIPAA and the New Social Media*

A patient sitting in the waiting room of an emergency department takes out a cell phone and uses the built-in camera to snap a few photos of the wounds of another patient. A greeter on duty witnesses this and immediately informs the triage nurse.  She asks the first patient to stop taking photos and to delete those she had taken in the waiting room. The shutterbug complies, and privacy is restored. Both HIPAA laws and the newer HITECH Act require that emergency departments protect patients’ privacy rights diligently.  This is becoming increasingly difficult as a result of advances in technology.

The Safety Toolkit

Sue Robinson, FRCP, FCEM
Ruth Brown, FRCS, FCEMEmergency Medicine in the UK is currently facing tough challenges. Many Emergency Departments are understaffed and facing an unprecedented increase in attendances whilst under intense pressure to achieve quantitative targets. These demands in conjunction with the findings of the Francis¹ and Berwick² reports means that the absolute requirement to deliver high quality and safe care in Emergency Departments has never been greater.  To help support our membership in this, the College of Emergency Medicine has developed the Safety Toolkit which aims to describe the structures, processes and skills required for a ‘safe’ department.

Good Metrics Back on Track

Mark Jaben, MD
For whatever reason, you want to reduce your door-to-doc times (D2D), currently an average of 25 minutes.  Perhaps you feel this is important for patient satisfaction, or the CEO wants to follow this metric, or your quality department uses this for reporting, or there is a billboard advertising this to the public. What will your first step be?