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emergency medicine

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.


Featured Clinician: Ed Eppler, MD, FACEP

Posted on Mon, Aug 08, 2016
Featured Clinician: Ed Eppler, MD, FACEP

The heart and soul of our practice are our clinicians. Meet Ed Eppler, MD, FACEP, an emergency physician in Indianapolis.

Years with EmCare: 3

Years practicing medicine: 20

Why did you decide to become a doctor? Why did you choose your specialty?  I’d like to say that medicine was a lifelong dream to serve others, but in realty I think it’s as simple as both of my parents worked in hospitals while I was growing up, and I followed in my their footsteps. I chose emergency medicine while rotating on a required family practice clerkship and admitting ER patients to our service. It was an instant love affair.

What career did you want to pursue when you were younger? I started college intending to attend law school. The business classes didn’t excite me, and I switched plans toward the end of my sophomore year.

What is in the pockets of your lab coat? Lint, a stethoscope, hospital ID, and scraps of papers with patient lists

What would be your ideal category on “Jeopardy”?  History

How do you stay organized at work? When we’re super busy I use scrap paper with hand written lists of patients with what’s pending.

What’s the best advice you’ve received about work or life? Life and your career is a marathon, not a sprint. Pace yourself personally and professionally. Don’t take the bait of thinking about purchases in terms of “it’s just another shift or two every month.” Keep your bills to a minimum, and experience the freedom of working because you want to, not because you have to.
What do you enjoy outside of work? Running and biking, theater shows and music, Netflix lazy days

What qualities make a successful doctor? Hard work, organizational skills, and empathy.  

If you could have dinner with anyone, living or historical, who would you choose and why? Julius Caesar.

What’s the most interesting place that you’ve been? Hiking through Eastern European Alps with my son last summer.

What’s your favorite TV show? Netflix. Is there anything else?


Featured Recruiter - Derek Sawyer

Posted on Mon, Feb 15, 2016
Featured Recruiter - Derek Sawyer

Looking to make a career change? Meet recruiter Derek Sawyer!

Name: Derek Sawyer    

Division: Alliance

Position: recruiter

Education: Bachelor’s degree in marketing from Stetson University

Location: based in Clearwater office (recruiting locations are all over)

Years with EmCare: just over 3

Years in the recruiting field? About 10 now

Why did you decide to become a recruiter? Didn’t even know it was a field when I first interviewed for the position. Just fell into it and was lucky that it fit me nicely.

How does your experience enable you to connect candidates with the right positions? I think the top two qualities of a recruiter are being able to listen and being resourceful. Instead of operating a cookie cutter, I simply try to gather as much data as possible and then rely on creativity and past experience to find unique solutions that fit providers wherever they are specifically in their career.

What makes EmCare different from other EM groups? The possibilities are endless. EmCare has such a diverse client group that there is always a new opportunity or position being developed. All of the unique fellowships, clinical sub-specialties and leadership openings that have been popping up lately have led to new areas of opportunity that weren’t even thought of a few years ago.

Describe your ideal candidate. Someone that is honest with me and more importantly themselves. Everyone is different but having an open dialogue about strengths, weaknesses, opportunities and threats (SWOT analysis) is the best way to ensure that there are no unforeseen issues down the road.

How important is the “relationship” between recruiter and candidate? Extremely.

What do you like most about working at EmCare? Building relationships.

What do you enjoy outside of work? Cooking and anything on the water.

What’s your favorite inspirational quote? Failing to prepare is preparing to fail.

What qualities make a successful recruiter? Hard work, availability and provider-first mentality.

What should residents do now to prepare themselves for future hiring opportunities? Make a list of preferences. This may seem silly, but openings come in all shapes and sizes, so it can be very difficult to compare unless you are very specific with your wants and needs in the beginning. Loans, family situation, location, clinical setting, future opportunities, etc., all are factors in determining what position will best suit both your long- and short-term goals.

Can you give an example of something a candidate has done that really impressed you during the recruiting process? Research. One of the more impressive interviews I went on was with a candidate who knew as much about the hospital as I did by the time we arrived onsite. He knew the CEO’s background and alma mater, which immediately started the meeting on the right foot. He pulled articles about challenges in the area and was prepared to speak on them as well as ask very pointed questions based on them.

What “insider tips” do you have for anyone applying to EmCare? Track down a recruiter and speak to them directly. The internet is a great tool for research but direct communication is most definitely the best bet.

Where do you look for candidates? Referrals are always my favorite way to recruit but certainly social media and the internet play a huge role these days. Those media are a great way to see what’s out there and compare with other geographical locations.

Tell me about your ideal candidate. What kind of clinical and educational experience is in demand now? Certainly clinical training and experience are of the utmost importance but there is another factor that seems to carry just as much weight lately and that is leadership. Not necessarily being a director but being able to lead the emergency department and all staff while on shift. As hospitals rely more and more on the emergency department as the hospital front door it can be difficult to juggle all the goals and responsibilities that are present. This makes it critical to establish great relationships with other providers, ancillary departments and most importantly the nursing staff to keep the team operating at the highest efficiency level possible.

Tell us something that most people at work don't know about you. I am an open book, so most of my coworkers know more than they bargained for!

If you could have dinner with anyone, living or historical, who would you choose and why? Tough one but I think Nelson Mandela would be pretty high on the list. Humility is a trait that I respect immensely and he is a personification of that. He also was a big sports fan which I can relate to as well…

What’s the most interesting place that you’ve been? I used to live in Portland, Ore., and while I am a bigger fan of the warm weather, I really enjoyed all the unique outdoor activities to do up there.

What personal accomplishment are you most proud of? Eagle Scout.


Emergency Medicine’s Expanding Role in Population Health

Posted on Wed, Feb 03, 2016
Emergency Medicine’s Expanding Role in Population Health

By Nick Zenarosa, M.D., FACEP

Traditionally, population health management has fallen to primary care providers (PCPs), but as more patients opt for the ED instead of a PCP, the responsibility of population health management is shifting.

Becker’s Hospital Review reports that nearly 80 percent of adults ages 18 to 64 visited the ED due to lack of access to other providers. An estimated 56 percent of primary care delivered in EDs is based on preventable, non-urgent visits, according to the Network for Excellence in Health Innovation (NEHI). And, the American College of Emergency Physicians finds that more than 33 percent of all primary care is performed by emergency medicine providers, yet they make up less than 5 percent of the primary care workforce.

An NEHI study identified the following five causes for patient use of the ED for primary care:

  • Patients have limited access to timely care services
  • The ED provides convenient after-hours and weekend care
  • The ED offers patients immediate reassurance about their medical conditions
  • Primary care providers refer patients to the ED
  • Hospitals have financial and legal obligations to treat all ED patients

The NEHI study further shows that increased insurance coverage under the Affordable Care Act will not drive patients to primary care. Findings indicate that the belief that ED overuse is the result of poor and uninsured seeking non-urgent care may be spurious – these populations were found to be a small subset of the overall population who were using EDs inappropriately. However, the Agency for Healthcare Research & Quality (AHRQ) indicates that if the ED staff encourages patients to an initial primary care visit, they will likely continue to see a PCP.

Disease Management Growing More Difficult, But There’s Hope

Particularly of concern for population health management is the management of chronic disease – especially the growth of Type 2 diabetes mellitus. It can lead to devastating complications such as renal disease, blindness, heart disease, stroke and impaired peripheral circulation. Blood glucose control, particularly decreased glycosylated hemoglobin, is associated with the delay or prevention of these complications. This type of control is achieved by close monitoring of diabetics’ blood glucose results, lifestyle management, diet and medication.
This close monitoring requires consistent, comprehensive care that is best offered in a primary care setting. However, access to primary care may be an issue for these patients.

If the trend of growing ED volumes continues, it could fall on emergency physicians to handle the proliferation of diabetes. Managing the disease requires knowing about it – screening high-risk individuals, actively looking for chronic conditions instead of passively finding out, discharging patients with long-acting insulin, oral hypoglycemic agents and diabetes education to get them started on a treatment plan. If the patient is not stable enough to go home, placement in the observation unit for medication initiation, including insulin and diabetes education, is a reality. He or she can follow up with a PCP, and return to the ED if unable to see PCP within the prescribed time. This approach could be applied to other chronic diseases.

Transitional care clinics, such as acute episodic care clinics, also offer a solution to chronic disease management. These clinics can be open seven days a week for 16 hours or 24 hours with the same triage processes as the ED. Between non-emergent patients and PCP patients looking for urgent care, this approach could save millions of dollars.

Coordinating Care through Established ED Demand Management Techniques

Emergency medicine professionals excel at demand management. Triaging, surge control and vertical flow are all tools that could have wider applications for population health and chronic disease management. ED staffs could improve clinical outcomes by coordinating patient care between the ED and primary care.

Emergency physicians can improve effectiveness and efficiency by coordinating care across the care team:
  • Communication with ED providers, ED nurses and others outside of the ED
  • ED flow rounds once a shift to ensure everyone on the multidisciplinary team is on the same page
  • Ensure successful transitions from the ED and plan for patients’ next steps
  • Engage patients as active participants in their care. Without patient and family involvement, the patient is unlikely to be able to manage their disease

A county-owned hospital with a Level-1 trauma center recently implemented some of these population health management techniques in its ED. The results aren’t scientific, just anecdotal, but they are promising:
  • A decrease of 28 to 49 hospital bed days per day
  • 3 percent decrease in inappropriate inpatient admissions related to diabetes
  • $158,000,000 in estimated expenses mitigated annually in aggregate
  • Tens of millions of estimated dollars at risk for Medicaid 1115 funding relative to ED process and access to primary care

Moving forward, the ED could use the following proposed metrics to measure success with Type 2 diabetes mellitus patients:
  • Number of patients initially diagnosed with Type 2 diabetes mellitus
  • Number of patients started on treatment plan
  • Number of patients transitioned to primary care clinics
  • Number of T2DM patients connected to a clinic who come to the ED for care before and three months after initiation of process
  • Decreased number of patients seen for medication refill

In this value-based purchasing environment, it’s more important than ever to keep the frequent ED visitors from doing what they’re used to doing – going straight to the ED when they don’t need emergency care. Getting out in front of population health by tapping the ED to help these “frequent flyers” formulate a more effective care plan could be the key to proactive, preventive care, less ED gridlock and fewer readmissions.

Nick Zenarosa

Nick Zenarosa, M.D., FACEP, is President of Integrative Emergency Services, an affiliate of EmCare. He currently serves as the System Medical Director of Emergency Services for Baylor Scott & White North Division. He also is Chairman of Emergency Medicine at John Peter Smith Hospital in Fort Worth, where he oversees the emergency department, the clinical decision unit, urgent care emergency department, and the emergency medicine residency program.

Dr. Zenarosa received his medical degree from the University of Illinois at Chicago College of Medicine. He completed an internal medicine residency at Parkland Memorial Hospital in Dallas and an emergency medicine residency at Carolinas Medical Center in Charlotte, N.C., where he was chief resident.


10 Tips for Emergency Medicine-Hospital Medicine Collaboration

Posted on Wed, Jan 13, 2016
10 Tips for Emergency Medicine-Hospital Medicine Collaboration

By Ginger Wirth, RN

According to Merriam-Webster, the full definition of collaborate is:

  1. To work jointly with others or together, especially in an intellectual endeavor
  2. To cooperate with or willingly assist an enemy of one's country and especially an occupying force
  3. To cooperate with an agency or instrumentality with which one is not immediately connected

I know that collaboration in healthcare can sometimes seem like assisting another country. The relationships between departments, disciplines, practices and partners have both rewards and challenges. Collaboration is key on so many levels to achieving the best outcomes and delivering the overall best care for patients. This is essential between nursing and providers in the emergency department when planning and executing care. Effective communication and collaboration plays into the safety, clinical quality and satisfaction of each patient’s visit.

Another important collaborative relationship is the emergency physician and the hospitalist. Continuity of care and the handoff of the admitted patient are essential to those same aspects of the patient’s overall experience: safety, satisfaction and clinical quality. This collaboration should happen not only when directly dealing with a patient, but also when processes, order sets or clinical pathways are being developed and reviewed. Healthcare is unique in the fact that we have governing and regulatory bodies that have standards, guidelines and measures that set basic expectations for outcomes. However, ultimately it is the provider-to-provider relationship and collaboration where the “magic happens.” Strong relationships among emergency medicine and hospital medicine teams have proven not only to meet standards but exceed them. Best practice is to have regular team meetings between these specialties to discuss opportunities and share the wins and outcomes of cases. Again, strong collaboration is a “win-win” for all – especially for the patients to which we provide care.

10 Lessons in Collaboration

Regardless of your industry, collaboration is so important. Here are some tips from Deborah B. Gardner PhD, RN, CS:
  • Lesson #1: Know thyself. Many realities exist simultaneously. Each person's reality is based on self-developed perceptions. Requisite to trusting yourself and others is in knowing your own mental model (biases, values, and goals).

  • Lesson #2: Learn to value and manage diversity. Differences are essential assets for effective collaborative processes and outcomes.

  • Lesson #3: Develop constructive conflict resolution skills. In the collaborative paradigm, conflict is viewed as natural and as an opportunity to deepen understanding and agreement.

  • Lesson #4: Use your power to create win-win situations. The sharing of power and the recognition of one's own power base is part of effective collaboration.

  • Lesson #5: Master interpersonal and process skills. Clinical competence, cooperation and flexibility are the most frequently identified attributes important to effective collaborative practice.

  • Lesson #6: Recognize that collaboration is a journey. The skill and knowledge needed for effective collaboration takes time and practice. Conflict resolution, clinical excellence, appreciative inquiry and knowledge of group process are all life-long learning skills.

  • Lesson #7: Leverage all multidisciplinary forums. Being present both physically and mentally in team forums can provide an opportunity to assess how and when to offer collaborative communications for partnership building.

  • Lesson #8: Appreciate that collaboration can occur spontaneously. Collaboration is a mutually established condition that can happen spontaneously if the right factors are in place.

  • Lesson #9: Balance autonomy and unity in collaborative relationships. Learn from your collaborative successes and failures. Becoming part of an exclusive team can be as bad as working in isolation. Be willing to seek feedback and admit mistakes. Be reflective, willing to seek feedback, and admit mistakes for dynamic balance.

  • Lesson #10: Remember that collaboration is not required for all decisions. Collaboration is not a panacea, nor is it needed in all situations.

To read more about emergency medicine-hospital medicine integration and collaboration, read our recent white paper, “Integration Changes Everything.”

Ginger Wirth

Ginger Wirth, RN, joined EmCare in 2013 as a Divisional Director of Clinical Services for the Alliance Group. Her goal is to make positive changes in healthcare by helping others focus on quality, excellence, and the overall patient experience. Wirth regards her role as Director of Clinical Services as the ideal opportunity to partner with nursing, physician and facility leaders to make positive changes to the entire patient care experience. Her 20-plus year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.

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