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emergency room

Facility Spotlight: 11 Reasons You'll Love Cypress Fairbanks Medical Center

Posted on Tue, Sep 16, 2014

Each month, EmCare features a client hospital to highlight the quality care available throughout the EmCare portfolio. To learn more about career opportunities at all EmCare-affiliated facilities, click here.

  1. Cypress Fairbanks Medical Center is located in Houston, TX—ranked #4 on the Forbes 2014 List of America’s Coolest Cities.
  2. Cy-Fair’s freestanding ER facility provides the same high quality care patients receive at facilities throughout the Cy-Fair Regional Health Network.
  3. Efficiency is paramount: Patients can check-in to Cy-Fair ER online which creates an efficient ER process for patients and staff.
  4. Cypress Fairbanks Medical Center Hospital was recently recognized for achievement in Mission: Lifeline®, a program created by the American Heart Association to help ensure prompt, evidence-based care for heart attack patients.
  5. Ranked among the top 10 Best Hospitals in the Houston metro area by US News & World Reports in 2011
  6. American Heart Association Get with the Guidelines Gold Performance Achievement Award for Heart Failure
  7. American Stroke Association Get with the Guidelines Silver Plus Performance Achievement Award for Stroke
  8. 2012 HealthGrades Coronary Intervention Excellence Award
  9. 2010 and 2011 HealthGrades Emergency Medicine Excellence Awards
  10. 2008/2009, 2009/2010, 2010/2011, 2011 and 2012 HealthGrades Maternity Care Excellence Awards
  11. Bariatric Surgery Center of Excellence from the American Society for Metabolic and Bariatric Surgery
To submit your CV for this exciting opportunity, click here!

Watch this video to learn more about Cypress Fairbanks Medical Center.


10 tactics to Reduce Violence in the Emergency Department

Posted on Tue, Aug 19, 2014
10 tactics to Reduce Violence in the Emergency Department

According to a survey by the International Association for Healthcare Security & Safety, the number of violent incidents involving hospital workers jumped 37 percent in the past three years. In this 3 part series, two EmCare-affiliated Divisional Directors of Clinical Services, share the details of their first-hand experience with violence in the ED and they reveal the improvements that need to be made within ER departments to reduce acts of violence in the hospital.

By Ginger Wirth, RN and Denise Sexton, RN, BSN, Divisional Directors of Clinical Services, EmCare


I was a victim of violence in the E.D. Here's my story. Pt. 1

I was a victim of violence in the E.D. Here's my story. Pt. 2 

  1. Teach staff to recognize aggressive and escalating behaviors early.  Be able to anticipate potential violent situations or patients/families that exhibit signs of increased stress, dissatisfaction or agitation.  Remember that overcrowding of ED’s, increased wait times and the ED’s being used as primary care clinics can have significant potential on increasing stress on patients, families or visitors.
  2. It is imperative that we provide education on how to deescalate aggressive or potentially violent customers.  This has to be real time training-- hands on, not the computer- based modules that we so often see on an annual basis in healthcare.  This training needs to be shown to all staff with a focus on the Emergency Department team, and should include drills or exercises to practice putting this training into action.  I understand that in other countries this happens on a regular basis.  We have disaster drills, fire drills, code blue drills, why are we not drilling on how to protect the staff, other patients and visitors in the hospitals?
  3. We need to educate the staff that there are Federal Laws in place to protect and prosecute those that do harm against healthcare workers.  This should be a zero tolerance initiative and treated as such in healthcare.  Staff should be encouraged to report any incidents-- small or large-- to administration and those incidents should be investigated and dealt with strictly and severely.  No longer should there be a stigma or fear or retribution for reporting incidents of violence.  This will take away the power from those assailants and give it back to the staff.
  4. Signs should be clearly posted in the Emergency Departments that any acts of aggression, disrespect or violence in the ED will not be tolerated and could result in law enforcement action.  I have seen these signs in a couple ED’s and I believe that informing the patients, families and visitors right in the beginning and reinforcing that with signs could help to deter events.
  5. Hospitals need to perform a root cause analysis of any and all incidents that occur in the facility.  In healthcare, we do these on all medical events that have adverse outcomes quickly and effectively.  Any type of violence needs to be treated the same and given the same attention.  The areas for improvement will show during these events and they demonstrate to any staff involved that these are serious events, and they will be investigated and addressed as such.
  6. ED team members need to treat all patients and their family members as if they have the potential to become violent. Never drop your guard with any of them.
  7. Be sure to undress the patients, put them in a hospital gown, and search for weapons. With most states adopting open carry laws for concealed weapons, you never know who may have a gun. We’ve removed many weapons over the years from patients,  most of which have been knives or other sharp objects. Clear the room of anything that they can use to harm you or themselves.
  8. Make sure that you have a code that you can call that will bring all available personnel to the ED. There is strength in numbers. I have seen many psych patients and irate family members become more cooperative with just a show of staff.
  9. Always position yourself with a way out of a room so you cannot be cornered by the patient. Never let a patient come between you and the door. Even a small patient can become unbelievably strong when adrenaline kicks in.
  10. Administration needs to be supportive and prosecute to the fullest extent of the law on any threats to healthcare workers. I have seen many patients and family members verbally abuse staff and think that they should take it.
What tips do you have for preventing violent episodes in your ED? Tell us in the comments. 


I was a victim of violence in the E.D. Here's my story. Pt. 1

I was a victim of violence in the E.D. Here's my story. Pt. 2 


I was a victim of violence in the E.D. Here's my story. Pt. 2

Posted on Tue, Aug 12, 2014
I was a victim of violence in the E.D. Here's my story. Pt. 2

According to a survey by the International Association for Healthcare Security & Safety, the number of violent incidents involving hospital workers jumped 37 percent in the past three years. In this 3 part series, two EmCare-affiliated Divisional Directors of Clinical Services, share the details of their first-hand experience with violence in the ED and they reveal the improvements that need to be made within ER departments to reduce acts of violence in the hospital.

By Ginger Wirth, RN, Divisional Director of Clinical Services, South Division

I have actually been a “victim” twice in my career while in the ED.  Both involved patients who had some mental/psychiatric etiology.  The first time was in 1990 while my team was providing a female patient with discharge instructions and calling her significant other for a ride home, she became agitated and punched me in the face.  This resulted in some pretty substantial bruising and some neck strain after I hit the floor. The facility fully supported me and charges were brought against the patient. She was found guilty of assault and received probation. 

The other time was also by a psych patient who became combative when he was told that he was going to be committed.  He began screaming and yelling at the staff and cornered me in the room and punched and kicked while trying to elope.

I don’t think there’s a lack of support from hospital administration, as I have had great support in both incidences.  I think the problem stems from the growing lack of treatment options throughout the country for mental health patients. Consequently, they are being dumped in the emergency departments.  No longer will the correctional system keep patients that have mental illnesses without medical clearance, causing these patients to clog and remain in the ED’s.  If police apprehend a person with any hint of a history of mental illness, they come to the ED for evaluation.  When they arrive in most ED’s, the providers are not comfortable initiating treatment for the mental illness even if there is a long history. 

For example, if a patient goes off their regular medications for depression and is picked up by law enforcement they are brought to the ED for clearance.  The ED providers may not be willing to shoulder the responsibility of restarting medications or discharging the patient without a psychiatric evaluation.  So, these patients remain in the ED until they can be stabilized.  Getting them into the mental health system can take days, weeks or sometimes months.  Also of note: many of these patients are self-pay and have a lack of resources to begin with, which hampers their entry into the overcrowded mental health system of many states. 

There has been some relief and “light at the end of the tunnel” for some areas with the increased usage of telemedicine.  In South Carolina, there is a fairly robust use of telepsychiatry; however, this has quickly succumbed to overuse and capacity issues.  The limited number of inpatient beds is a problem for patients with insurance, as well as the uninsured.  We have an opportunity to continue with training in our EDs to recognize aggressive situations, provide support for our ED providers in the care of the mental health patients in the community and what resources are available and how to access these resources easily and timely. 

All staff in the ED must know that violence against healthcare providers should NEVER be tolerated, expected or dismissed.  All cases should be reported to the facility administration and law enforcement when appropriate.  Abuse is just as unacceptable for someone that cares for patients, as it is for the patients themselves.


Ginger joined EmCare in 2013 as a Divisional Director of Clinical Services for the South Division with the strong belief that she could continue to make positive changes within healthcare by helping others focus on quality, excellence and the overall patient experience. Ginger 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+ year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients. 


I was a victim of violence in the E.D. Here's my story. Pt. 1

Have you witnessed violence in your ED? What steps can staff take to protect themselves and the other patients in their care? Tell us about it in the comments. Next week: In part 3 of this 3-part series, Ginger Wirth and Denise Sexton provide tips to  reduce instances of ED violence in hospitals.  


I was a victim of violence in the E.D. Here's my story. Pt. 1

Posted on Wed, Aug 06, 2014
I was a victim of violence in the E.D. Here's my story. Pt. 1

According to a survey by the International Association for [DeniseSexton photo] Healthcare Security & Safety, the number of violent incidents involving hospital workers jumped 37 percent in the past three years. In this 3 part series, two EmCare-affiliated Divisional Directors of Clinical Services, share the details of their first-hand experience with violence in the ED and they reveal the improvements that need to be made within emergency departments to reduce acts of violence in the hospital.

By Denise Sexton, RN, BSN, Divisional Director of Clinical Services, EmCare

Working in the emergency department can go from boring to over the top in just a few seconds. That is what draws most people to emergency medicine. Emergency departments care for everyone that comes through the doors — from patients with a simple toothache to patients with level 1 trauma. With the decrease in mental health facilities and inpatient psychiatric units, we also get psychiatric patients. These patients can be very unpredictable. They can range from the mildly depressed to the acutely psychotic patient who can break out of 4-point restraints.

The police frequently bring patients to the emergency department for clearance before they can take them to jail. In many cities, anyone in custody who appears to be even mildly depressed or suicidal gets brought in for evaluation by the emergency department physicians.

The facility where I worked had an inpatient adult psychiatric unit. So, a majority of the patients we treated were psychiatric patients. On one particular occasion, a patient was brought in by the local EMS. This person was not much bigger than me. The patient was feeling mildly suicidal. I triaged and assessed the patient in the room. Everything was fine. I told him that he would have to get undressed, his personal belongings would be searched and removed from the room, labs would be drawn, and then when the results were back and he was medically cleared, the mental health clinician would be in to evaluate him. This generally took about 2-3 hours. He was very cooperative, got undressed and into his gown and was searched. At that point, I went to the nurses’ station to do my charting. The security guard was with the patient and the lab tech went in to draw blood.

In a split second, the patient jumped out of bed. He punched out the security guard and ran into the hallway. Our healthcare tech, who was much larger than the patient, tried to stop him and got thrown to the ground and punched. The patient then ran into another patient’s room and punched a family member. I was standing in front of the exit door and saw the patient running towards me. I knew by the look in his eyes that he had completely lost it. I stepped aside and decided to let him run out the door. I figured he would be easy to find in only a hospital gown. He looked at me when I stepped aside and said “and you too.” And, wham! He hit me in the face. I looked at the video footage later and saw myself fly about 5 feet across the floor. After the hit, I curled up in hopes that he did not hit me anymore.

He ran out the door and was apprehended a short while later by the police. While all of this was happening, the staff hit the panic button which alerted all the police in the area and called a code in the hospital so all the hospital staff came running. All of this happened in less than 2 minutes.

The hospital was very supportive of all of us during and after this. The patient had to be brought back to our facility for treatment and evaluation, but was transferred to the state facility fairly quickly. Everyone was on guard when he came back. I never knew what happened to the patient after that, but I know he was facing multiple charges.

Was there anything that could have been done differently? I have asked myself that many times. I always come up with the same answer “No.” I have taken care of hundreds of psych patients and this patient gave no indication that he was going to act out like he did. None of us saw this type of behavior coming. When we performed the Root Cause Analysis of the incident, we all agreed that the behavior was not expected from this individual and we have no idea what pushed him over the edge.


Denise Sexton offers 20 years of healthcare experience to EmCare partner hospitals, and over 15 years specifically in the emergency department and in leadership roles. As a Divisional Director of Clinical Services for EmCare, Denise’s strength in leadership and diverse clinical skills provides a solid foundation for improving hospital operations, not only in the E.D, but also with services including hospitalist programs, observation units, operating rooms and critical care units. Denise uses her education and experience to offer expertise and broad perspectives for E.D. and inpatient managers.

Do you have a story of violence in your ED? What steps has your hospital taken to prevent violence? Tell us in the comments. Next week: In part 2 of this 3-part series, Ginger Wirth shares her experience with violence in the ED.


Meeting Planner: Schedule or ambush? Formal or Casual? Ideas for Becoming a Meeting Master

Posted on Thu, Jul 24, 2014

EmCare Director of Clinical Services

465134963.jpgSome administrators feel their entire day is filled with nothing but meetings. Physicians can feel this frustration as well and tend do not want to set established meeting times with administrators because of it. If you’re among those frustrated by “over-meeting,” you might want to consider encounters such as phone calls, hallway visits and pre-and post- meeting tags on meetings – these can be less formal and less intense than traditional meetings.

Advantages of “hallway” meetings:

  • Quick, easy and informal – they can set people at ease without anticipation of a “difficult” meeting
  • Allows for more conversations in a given day, since you can conceivably reach many more people and topics in a day. It’s “guerilla warfare,” much like an E.D. environment!

Disadvantages of “hallway” meetings:
  • Administrators might not be prepared for these encounters
  • They can be distractions to what the administrator was previously doing
  • The administrator might be distracted thinking about other projects
  • There is generally more power and meaning in an established, set, scheduled meeting with the administrator.

Advantages of an established meeting with preset agenda:
  • The administrator’s calendar has your name and topic on it, allowing for all involved to be prepared for the discussion  160945489.jpg
  • You are probably more likely to have the administrator’s full, undivided attention 
  • The administrator will likely be more prepared 
  • You are sending a message that you value the administrator’s time – this can be very important! 
  • You are entering into their comfort zone which may allow them to make better decisions 
  • There is probably more organization to the meeting (especially with a preset agenda). This can better demonstrate your organization skills and professionalism. 
  • It can be easier to take notes. (Watch administrators during meetings...they generally take notes, which is more difficult to do with hallway conversations or phone calls.)

Keys to success of traditional meetings:
  • First, arrive on time. Administrators usually don’t like to wait. Theygenerally also know the value of their medical staff’s time as well and will do everything in their power to show up to your meeting on time themselves.
  • The attention span of an administrator can be extremely short. Keep this in mind when determining the length of the meeting, developing the agenda and managing the agenda. 
  • Know your agenda items: prepare in advance and don’t come in five or ten minutes prior to prepare.
  • Have supporting documents and make copies for the administrator. Take notes on key questions and comments from the administrator and follow up on these items
  • Manage the meeting to end on time. If you are able to wrap up even five minutes early, you could make the administrator’s day! If you find the meeting is going to run over, wrap it up anyway with a comment like “We are running out of time and I want to value your schedule and I would like to continue this discussion prior to our next meeting. Would you like to make another appointment?” You could be met with a response such as, “No, let’s continue the conversation” or “Yes, let’s set up another time.” The administrator may not express immediate gratitude, but may have a sense of respect for your professionalism.

Once this type of meeting takes place on a regular basis, the hallway type meetings become more effective than before.

About Ken Stackhouse:

kenstackhouse-2013-cropped.jpgWith more than 30 years of healthcare experience, Ken Stackhouse has been a Divisional Director of Clinical Services (DDCS) for EmCare since 2007 and currently practices as an emergency department (E.D.) nurse practitioner. Prior to joining EmCare, Ken worked as Director of Patient Care and Emergency Services at Corpus Christi Medical Center in Texas and Director of Emergency Services and EMS at Baylor Regional Medical Center in Grapevine, Tex. He has also held such titles as Director of Day Surgery/Endoscopy, Trauma Coordinator, Staff Registered Nurse (R.N.) and Firefighter/Paramedic.

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