ED practices 'golden rule' with hospital staff
Expanded scope of practice eases burden of others
"Every doctor in our group tries to put themselves in the shoes of the medical staff, and ask themselves what they would want done prior to admission and how they would want their patients treated," says Ben Johnston, MD, president of the emergency physician group at Morris (IL) Hospital.
It is that attitude that helped the ED receive the Top Performer Award for Emergency Services in the medical staff perception category from Professional Research Consultants (Omaha, NE) for the second consecutive year. This award means Morris Hospital & Healthcare Centers received the highest score for quality of care in the ED when compared to other hospitals across the country using the same physician satisfaction survey tool.
Johnston is convinced that while the category speaks of "staff perception," there is a "one-to-one" relationship between that perception and the delivery of quality care. Carol Havel, RN, MS, vice president of patient care services, agrees. "We have good quality scores all along if you look on Hospital Compare" at www.hospitalcompare.hhs.gov, she says.
John Williamson, DO, an ED physician, says one of the things they do particularly well is initial work-up and assessment. "We get things started on the right path as far as diagnosis and work-up and communicating with the attendings," Williamson says.
"Our initial assessment of the patient, work-up, treatment in the emergency department, and discussion with the attending physicians helps to start the patient on the appropriate treatment path," he explains. "I feel that taking the time to listen to our patients helps to develop a trusting relationship with the patients and their families, and the emergency department's caring attitude toward our patients also helps to establish that trust."
How does this "Golden Rule" approach by the ED staff play out? "You have to take things from the perspective of the medical staff," says Johnston. He gives the hypothetical example of a patient presenting with belly pain at 4 p.m. Recognizing that "surgeons want to go home," he will call them up and ask if they want a CT scan. "Clinically, I may not have enough information to know if it's an 'appy' [appendectomy] or not," he says. "If I'm a surgeon, at least I want the option [to do a scan first]."
Chest pain patients often end up getting admitted, but, says Johnston, "If I can call the cardiologist and get a stress test, we might be able to send the patient home. If you're on the other end of the phone, that's how you want to be treated."
Johnston says a broad scope of practice also enables his staff to ease the burden of specialists in the hospital. "I talked to a friend mine of mine who's an internist at Northwestern, and he was shocked by our scope of practice," he shares. For example, if the ED gets a patient with an extremity fracture that can be reduced, the orthopedic surgeon is never called. "This also moves things along very fast," says Johnston, adding that his staff also are "comfortable with procedural sedation." The hospital's orthopedic surgeons "are very comfortable with our procedures," he says.
In addition, Johnston says, "We do not call in plastic surgeons unless there's an underlying problem. We are very comfortable with closures." A general surgeon, he adds, is not called unless the patient is going to the OR.
Nurse/doc rapport boosts quality
Johnston says excellent communication between ED physicians and nurses was a key contributing factor to his department receiving the Top Performer Award for Emergency Services in the medical staff perception category from Professional Research Consultants (Omaha, NE) for the second consecutive year.
Havel agrees. "The doctors are very knowledgeable and also approachable," she says. "They're willing to teach and share information — not only with other doctors, but they are also good mentors to the nursing staff."
Johnston adds, "We think of nurses as colleagues, not people who should do what we tell them. From our perspective, doctors may have all this book knowledge, but nurses have been doing this for years, too, and they are extremely good at pattern reactions — spectacular, in fact, at gut feelings — and I want to hear about that."
Havel says, "From a nursing perspective, it's important to do a good assessment and then share it with the physician. What they don't know they can't act on."
Williamson recalls several cases where the patient was going to discharge, and a nurse would pose an important question. "Instead of blowing them off, we reassessed the patients," he says.
Johnston recalls one particular instance in which a charge nurse questioned his diagnosis of deep vein thrombosis. She asked him if he wanted to order an ultrasound as a precaution, and he did. "If we hadn't done that, the patient would have been sent back to the nursing home with a pulmonary embolus," Johnston says. Instead, he notes, they were admitted and received good care.
Because of instances like these, he explains, the physicians encourage nurses to practice medicine in the full scope of their capabilities. "I never want nurses shut down," he says.
In fact, Johnston says, if someone is not interacting properly with the nursing staff, there will be a discussion with that physician about treating nurses with respect. What's more, he says, "We do not hire a physician we do not feel will interact well with the nurses. If I saw someone who gave great care but did not treat others in a collegial manager, I would not hire that person."
Sources
For more information on developing good relationships with hospital medical staff, contact:
- Carol Havel, RN, MS, Vice President of Patient Care Services; Ben Johnston, MD Emergency Department; or John Williamson, DO, ED physician, Morris (IL) Hospital. Phone: (815) 942-2932.
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