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Use of APPs at Critical-Access Facility Earns National Award

Posted on Wed, Jan 04, 2017
Use of APPs at Critical-Access Facility Earns National Award

By Diane Simerly, RN

Faced with physician recruiting challenges and a strained relationship with the community, EmCare’s team at CHI St. Luke’s Health Memorial San Augustine set out to change the culture at the 18-bed critical-access hospital, winning a national award in the process.

This fall, our team’s hard work at CHI St. Luke’s Health Memorial San Augustine in San Augustine, Texas, earned an Excellence Through Insight award for Most Improved Overall Emergency Department Experience for hospitals with less than 100 beds from Healthstream, a national third-party organization dedicated to improving patient outcomes.

The Excellence Through Insight awards recognize organizations that excel in their ability to gain insight into their patients, employees, physicians and consumers through research and to use that information to build excellence within their organization.

After analyzing the issues at San Augustine, Adam Corley, MD, an executive vice president with EmCare, suggested using seasoned, high-functioning advanced practice providers (APPs) to solve the problem, and offered to serve as the sponsoring physician via computer or mobile phone. Our team presented the concept to hospital and system administrators.

Once given the green light, Dr. Corley and Peni Russell, NP, carefully reviewed clinical candidates, focusing on those with a high skill level and a positive attitude for working with clinical staff, local providers and the community.

“The success of this initiative hinged on hiring right,” explained Dr. Corley. “Once the right clinicians were in place, the team’s mantra was to do what’s right for the patient, treat patients and their family members well, and follow best practice for clinical outcomes.”

For example, a local young adult has a unique condition that can create a great deal of pain. She has a team of doctors at the closest tertiary facility, which is two to three hours away. San Augustine has become her preferred facility for acute pain control on a frequent basis. However, staff became concerned about professional liability as the patient returned more than once in 24 hours for pain medication Russell and Darlene Williams, RN, chief executive officer, collaborated to develop a care map and order set agreed upon by Nursing and providers to provide safe care while adequately addressing the patient’s pain needs.

The San Augustine and EmCare team continues to improve quality services.

Diane Simerly

Diane Simerly is a director of clinical services with EmCare.

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Lessons from the Olympics: Be a Mentor, Never Stop Improving

Posted on Mon, Aug 29, 2016
Lessons from the Olympics: Be a Mentor, Never Stop Improving

By Adam Corley, MD, FACEP, FAAEM

Anyone who knows me well would tell you that I am not a sports fan. I don’t follow football, baseball, basketball, UFC, the Kentucky Derby or the Olympics. I usually make a token attempt at keeping a baseline sports knowledge and vocabulary so that I can at least be minimally social, but unfortunately, I usually fall embarrassingly short.
 
However, even to a sports dunce like me, several moments and lessons from this year’s Summer Olympics hit home. Michael Phelps sailing into the record books as the most decorated Olympian of all times certainly makes my personal highlight reel. But an almost more inspiring story belongs to Joseph Schooling.
 
Schooling, a Singapore native now attending the University of Texas, met his hero Michael Phelps in 2008 in advance of Phelps' incredible Olympic performance. Phelps graciously took a photo with Schooling – a photo that now lives in social media infamy.
 
The New York Times quoted Schooling as saying “As a kid, I wanted to be like him. A lot of this is because of Michael. He is the reason that I wanted to be a better swimmer."
 
To me, the Phelps-Schooling story says a few things. First, we all need mentors, coaches and inspirational figures in our lives. There are hundreds of people who inspire me in one way or another. I have dozens of mentors and a few coaches, all of whom I rely on for advice, direction, inspiration and guidance. I appreciate each and every one of them and know that I need their help to be successful.
 
Secondly, I think that it's important to remember that there is a very good chance that you inspire someone. You may be their mentor, inspiration or idol. If you are given the chance to be a mentor, take it. Teach. Coach. Advise. Guide. Give others the benefit of your training and experience. Leave your profession, your hospital, your ER or your community a better place by making the generation that follows even better and more successful.
 
I think that my favorite lesson from the 2016 Olympics is a historical one. In 1972, American Mark Spitz stunned the world by winning seven gold medals in Olympic swimming. Spitz set a world record that year by swimming the 200m freestyle in 1:52.78 – an incredible accomplishment by any standard.
 
The slowest time recorded in the 2016 Rio Olympics 200m freestyle was 1:45.91. Spitz's world record swim from 1972 would not have even made the Olympic finals 44 years later.
 
The Munich to Rio freestyle story should serve to remind us that we must never be satisfied. Never satiated. Never stop trying to be better. Yesterday’s world record is tomorrow’s last place. There are always ways to innovate and improve. Just because you are good, great or even the best for a moment doesn’t mean that you can stop or rest on your laurels. We as doctors, nurses, nurse practitioners, physician assistants, CRNAs and administrators must never stop pushing the flywheel.



Dr. Adam Corley is a practicing emergency physician with more than 10 years of clinical and leadership experience. Dr. Corley serves as Executive Vice President for EmCare’s West Division. He also serves as the medical director for several EMS services and the Anderson County Texas Sheriff’s Department. Dr. Corley lectures and writes on a variety of topics, including decision science and behavioral economics, management of disruptive behavior in healthcare, conflict resolution and healthcare leadership.
 

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Physicians Should Advocate for Ridesharing Services to Save Lives

Posted on Wed, Jun 08, 2016
Physicians Should Advocate for Ridesharing Services to Save Lives

By Adam Corley, MD, FACEP
 
Several weeks ago, I met an old friend for dinner at an Italian restaurant in Dallas. Since I thought we might have a cocktail or a glass of wine, I decided not to drive and used the ridesharing app Uber instead. It turns out that he had the same thought and used Uber as well. We spent some time over dinner discussing Uber and other ridesharing applications, their economic impact, public health implications and whether or not they reduce individual risk.
 
Uber is one of a relatively new class of smartphone apps that connects people who need a ride with drivers contracted with the company but using their personal vehicles. When a ride is requested, a message goes out to nearby drivers with the location of the pick up. The drivers then decide if they would like to commit to the fare. After a driver accepts the ride, his or her name, phone number and location as well as estimated time of arrival are readily available to the customer. The service is reasonably priced and is connected directly to a credit card on file, thus eliminating the need to provide cash or credit card to the driver at your destination.
 
As you might guess, my friend and I were not the first people to ponder the significance of Uber, Lyft and other ridesharing services. Brad Greenwald and Sunil Wattal of Temple University published a paper last year where they compared vehicular homicide rates in California cities before and after entry of Uber into the market. Their results show that “entry of Uber X results in a 3.6 percent to 5.6 percent decrease in the rate of motor vehicle homicides per quarter in the state of California.”
 
Greenwald and Wattal estimate that full, nationwide implementation of Uber would save 500 lives and approximately $1.3 billion taxpayer dollars annually.
 
Bill Spencer, investigative reporter for News 2 in Houston, reported that in 2013 there were 6,205 arrests for driving while intoxicated in Houston. In 2014, a year after Uber’s entry, arrests were down to 5,182. This represents a year-over-year reduction in DWI arrests of 16.5 percent.
 
I will be the first to admit that correlation does not equal causation and that this data is not bullet proof. However, this evidence supports the intuitive conclusion that easy access to reliable and inexpensive transportation that substitutes for driving while intoxicated will reduce accidents and save lives.
 
Unfortunately, not everyone shares my positive view of Uber and other ridesharing apps. Several cities have either limited or significantly regulated ridesharing.
 
Last December, the Austin City Council considered 12 pages of new and expanded regulations governing ridesharing applications. Fingerprint background checks, approved trade dress, robust data reporting to the government, prohibition of drivers accepting street hails, and a fee paid to the City of Austin were included in the proposal.
 
Austin Police Chief Art Acevedo told the City Council, “Data here and around the country shows that TNCs (transportation network companies)…getting people off the streets and home safely helps with our DWI problem, no argument about it.” Travis County Sheriff Greg Hamilton said “drunk driving in Austin is an epidemic. It is my strong opinion that we ensure that TNC companies remain operational in Austin, as they provide a critical service that is keeping Austin much safer that we were without them.”
 
Despite the objections from Chief Acevedo and Sheriff Hamilton and despite the intuitive reasoning and scientific research validating the benefit of ridesharing, the new ordinances passed.
 
Uber and Lyft not only didn’t find value in the new regulations but they didn’t believe them to be consistent with their long-term business models. In response to the new ordinance, 65,000 signatures were collected to put the new regulations in front of voters and a special election was held in May.
 
With 17 percent of registered voters turning out to cast their ballots, the ordinance was upheld 56 percent to 44 percent. Uber and Lyft have now ceased operations in Austin and approximately 10,000 drivers are no longer able use a phone app to partner with potential customers.
 
From a public health standpoint, I think that the impact is clear – there will be more DWI arrests and more accidents and deaths from drunk driving now that Uber and Lyft are gone. Whether you feel Austin’s regulations were reasonable or not, we as physicians should work with our cities and states to create a political and regulatory environment where ridesharing is an available, safe and attractive option to drinking and driving.

Adam Corley
 
Adam Corley, MD, FACEP, is a practicing emergency physician with more than 10 years of clinical and leadership experience. Dr. Corley serves as Executive Vice President for EmCare’s West Division. He also serves as the medical director for several EMS services and the Anderson County Texas Sheriff’s Department. Dr. Corley lectures and writes on a variety of topics, including decision science and behavioral economics, management of disruptive behavior in healthcare, conflict resolution and healthcare leadership.
 

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