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Specialty Training Program for APPs Wins Award for Innovation

Posted on Thu, May 18, 2017
Specialty Training Program for APPs Wins Award for Innovation

A new program is empowering emergency department advanced practice providers (APPs) to practice at the top of their license, which is helping enhance the delivery of care and improve productivity, job satisfaction and clinician turnover rates at collaborating Envision Physician Services facilities.

Lynden Pelbath, PA-C, MBA, regional director of APP services at Envision Physician Services, and Adam Brown, M.D., MBA, regional medical director at Envision Physician Services, developed the APP Skills, Training, Experience and Professional Credential (STEP) program. They are the recipients of Envision Physician Services’ prestigious 2017 Genesis Cup award.

“I am honored to receive the recognition and proud to have the opportunity to promote the successful development of APP programs,” Pelbath said. “Nurse practitioners, physician assistants and other advanced practice providers are essential to the healthcare system. When we perform the initial evaluation and advanced treatment on high-acuity patients presenting to the emergency department, we lessen the burden on physicians, improve operational efficiency and enhance the patient-caregiver experience.”

The Genesis Cup is an award for healthcare innovation presented each year by Envision Physician Services. Pelbath and Brown presented their award-winning APP STEP program, which prepares APPs to become expert emergency medicine caregivers, at the Envision Physician Services 2017 Annual Leadership Conference held in Las Vegas April 18-20.

In the emergency department, there are wide variances in APPs’ experience and capabilities. APP STEP is minimizing that gap. Providers first undergo a skills assessment for placement in one of the program’s three stages. Then, with the appropriate education and training, they advance through the program. In addition to leveraging on-site experience, the program requires advanced certification and continuing medical education training.

Together, Pelbath and Brown launched the pilot program at the beginning of 2015 at Sentara Northern Virginia Medical Center in Woodbridge, Va. Initially, nine APPs who primarily triaged and tended to patients with mild ailments and minor injuries participated in the program. Currently 21 APPS are providing the same level of care and are working in the intermediate care, acute care and observation units. Pelbath and Brown have since implemented the program in five additional Envision Physician Services sites throughout the north division with more than 50 APPs participating.

“We are committed to supporting our providers and equipping them with the tools they need to provide quality care,” Brown said. “APP STEP is easy to implement in all sites and hospital departments, and we find that our partnering facilities experience improved productivity and patient outcomes. I am extremely proud of what we have been able to accomplish and look forward to broadening the reach of the program.”

The Genesis Cup program recognizes and celebrates the creativity and innovation of everyday physicians as part of the company’s ongoing pursuit to improve the delivery of patient care. In addition to recognizing the inventor/innovator, the Genesis Cup acknowledges those involved in the initiative and the regional office supporting such endeavors.

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National Nurses Week: Finding Balance

Posted on Mon, May 08, 2017
National Nurses Week: Finding Balance

By Ginger Wirth, RN

Nurses, like most healthcare professionals, struggle with work/life balance. This stems from the reason that most of us pursued a career in healthcare – an innate desire to care for others.

Your interest in the field may have developed from early exposure to some aspect of healthcare. A family member or personal experience with your own or someone else’s medical issues can ignite the passion for the art of caring for others.

That passion for making a difference in the lives of patients, families and those we work with takes center stage for most nurses in the industry. There are times when our personal needs are put aside, our schedules changed and, sadly, family milestones are missed to execute our craft to the best of our abilities. This apparent oversight is never intentional, but it often creates conflict in our home lives.

It’s a constant struggle to find that delicate balance. This was brought to my attention by my then-5-year-old son, who asked me at the dinner table one evening several years ago, “Mom, are you going to be a nurse forever?” It was a strange question, to be sure, but our dinner table was usually where I’d recount my day in the emergency department. I answered honestly, “Of course I’ll be a nurse forever.” He then bluntly retorted, “Well, then you will never see your grandkids!” and promptly went back to eating his macaroni and cheese. Out of the mouths of babes … I have thought about that question many times throughout the rest of my almost 30-year career. I use it as a barometer when whatever in my professional career seems to be consuming all of my time, or I have inadvertently missed something important in my “outside life.”

Those close to you – your family and friends – deserve your attention and time. A true balance of both only makes you stronger, and both parts of your life get better. And, I would be remiss if I didn’t mention that it’s also important to take time to care for yourself. We cannot effectively take care of others if we are not taking care of ourselves. I wrote a blog article with some tips you may find useful.

The impact that we are able to make on the world through a career in healthcare, and in nursing in particular, is immeasurable. That is undeniable, and truly makes the world a better place.

Ginger Wirth

Ginger Wirth, RN, joined Envision Physician Services in 2013 as a divisional director of clinical services. 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 the ideal opportunity to partner with nursing, physicians and facility leaders to make positive changes to the entire patient care experience. Her nearly 30-year nursing career has been dedicated to quality and excellence, promoting overall positive outcomes and safety for patients.

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Emergency Physician’s Photography Featured at New Smithsonian Exhibition

Posted on Wed, Apr 12, 2017
Emergency Physician’s Photography Featured at New Smithsonian Exhibition

Envision physician Jeff Gusky, MD, FACEP, lives two lives: one as an emergency physician and the other as a National Geographic photographer, explorer and now television host. His photographs and discoveries have been featured in media and museums around the world – and even on Broadway.

Dr. Gusky, who is an emergency physician at Emergis ER locations in Dallas and Fort Worth, was fortunate to find and photograph a hidden world of World War I, modern underground cities beneath the former trenches in France that once housed tens of thousands of troops at any given time. They were equipped with electricity, railways, telecommunications and the infrastructure of a modern city. One site is more than 25 miles underground in one place, another housed 24,000 troops underground and had a 700-bed hospital. Almost all of these findings are beneath private farmland and unknown to the outside world, even today. Now in complete darkness are thousands of messages that soldiers left behind: notes to loved ones, museum-quality art and inscriptions, names and addresses – a hidden world frozen in time.

The 100-year anniversary of the United States entering World War I was last week. On April 6, an 18-month exhibition of Dr. Gusky’s work opened at The Smithsonian National Air and Space Museum in Washington, D.C. More than 13 million people are expected to visit the exhibition. This short video, which is part of the exhibition, underscores the connection between emergency medicine, art and exploration.

“My mission as an explorer and artist is identical to my mission in the ER: to help people see and avoid danger,” explains Dr. Gusky. “I strive to inspire hope about the future among ordinary citizens by encouraging people to ask questions about modern life we have forgotten how to ask and by helping to create a language for us to talk about how technology and life in cities affects conscience.”

He made his debut as a television host March 13 on the Smithsonian Channel when the documentary titled “Americans Underground: Secret City of WWI” aired.

Dr. Gusky’s career as an explorer and artist began on a bleak day in December 1995 at the former Nazi concentration camp Plazow, just outside Cracow, Poland. Acting on a hunch while visiting a memorial near the camp’s entrance, he climbed a nearby hill in knee-deep snow. Approaching the top, a barbed wire fence came into view surrounding a Nazi-era compound: an abandoned building with prison-bar windows next to a set of ovens, ashes still present. In the dim light and silence, Dr. Gusky experienced a strong sense that unspeakable acts of barbarism once occurred there. Guided by intuition, he began photographing what he felt, the same method he uses today.
 
Since that day, Dr. Gusky has been on a quest to understand why mass murder and terrorism still threatens us. Exploring places in Poland, Belgium, France, Moldova, Ukraine, Transnistria and Romania, where millions of innocent people have been slaughtered in modern times, he has discovered a common thread to every modern mass murder.
 
“Technology and the inhuman scale of modern life endangers us by making us feel like machines and by disabling our moral compass,” Dr. Gusky said. “My work seeks to help communicate the looming human emergency caused by compromises we make that diminish our humanness.”
 
Dr. Gusky’s first year of medical school at the University of Washington was spent in Alaska as part of the WAMI (Washington, Alaska, Montana and Idaho) Program, created to inspire students to become country doctors. After graduation, he combined his love of flying and rural medicine and used his plane to reach remote hospital emergency rooms on short notice throughout Texas and Oklahoma. Since 1991, he has taught trauma skills to other physicians as an instructor in the Advanced Trauma Life Support program. He is a member of Alpha Omega Alpha and a fellow of the American College of Emergency Physicians.
 
He has published three books, and frequently posts new photographs and videos on his website and social media channels. Several other television productions are in the pipeline.

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6 Strategies for the Organized Mind

Posted on Mon, Apr 10, 2017
6 Strategies for the Organized Mind

Healthcare professionals have mastered the art of multi-tasking. But, the skill that has long been valued is now seen as a liability, especially with the new and increased focus on high-quality, error-free care. This was the premise of a keynote address titled, “The Organized Mind and Information Overload,” that Daniel Levitin, Ph.D., recently delivered. Dr. Levitin is a James McGill Professor of psychology, behavioral neuroscience and music at McGill University in Montreal. He is also the author of several books including the No. 1 best-seller, “The Organized Mind: Thinking Straight in the Age of Information Overload.”

Dr. Levitin told attendees that information overload often causes mistakes and that it can lead to deadly consequences in the hospital. Taking a cue from other industries that have pioneered efforts in safety and high reliability, such as aviation and heavy machinery, researchers are now studying the causes and effects of interruptions and distractions in the clinic.

It is easy to understand the potential impact interruptions have on patient safety. A 2005 study conducted by Alvarez and Correra of a hospital intensive care unit (ICU) identified 838 interruptions in 24 hours for an attending staff of nine physicians. The study identified two types of interruptions – turn-taking interruptions (where the person speaking is interrupted by the person he or she is speaking to) and breaking into a conversation interruptions (a third person interrupts a conversation that is occurring between two people). People tend to interrupt because they feel they need to know something immediately.

A 2010 study of ICU nurses by Anthony identified 75 interruptions during medication preparation in an eight-hour shift. Recognizing the potential for medication errors, the hospital placed red tape around the central medication area and the medication prep cart, designating the space as a “no interruption zone.” Medication errors fell by 50 percent as a result of this proactive intervention.

Dr. Levitin led the audience through six major themes that appear to be getting worse in the hospital setting. First, he discussed the Myth of Multi-Tasking. “The brain simply doesn’t work that way,” he explained. “When presented with a task, a project file opens in the cortex. As additional tasks or interruptions occur, new project files are opened. As the brain shifts from one thing to another, you are not fully engaged in any one thing. You deplete your neuro resources every time you switch because switching releases cortisol that causes interference in a variety of ways – increased heart rate, elevated blood pressure and disrupted digestive system. All of these can contribute to foggy thinking, sort of like being drunk, but you aren’t aware of it.”

“Uni-taskers” get more done, are more creative and produce higher quality work output than multi-taskers,” Dr. Levitin said. Other industries recognize this phenomenon and have instituted policies to mitigate it. For example, pilots cannot have unnecessary conversations below 10,000 feet. This rule enables them to focus solely on critical conversations with one another and with air traffic control. Air traffic controllers are required to take a break after working two hours. Likewise, to stay fresh and focused, translators at the United Nations cannot work more than 90 minutes consecutively.

The second theme was the Importance of Naps and Breaks. Dr. Levitin said we don’t fully understand why a 15-minute break if done correctly, can hit the “neuro reset” button in the brain. He cited research that identified the default mode network comprised of the central executive mode and daydreaming or mind-wandering mode. The central executive mode keeps you on-task and fully focused so that everything goes right. There is a distinct set of neuro circuits that are involved in this state. When you are in the daydreaming or mind-wandering mode, your thoughts are loosely connected from one moment to the next. This is the mode of the brain in which spent glucose is restored. It is also the most creative mode and one that enables us to think and solve problems. People do many things to enter this mode such as listening to music, immersing themselves in nature or going for a walk. In this mode, your mind wanders non-linearly making connections between things that normally don’t go together and, as a result, making solutions more apparent. Snacking during the day is also beneficial in restoring glucose. Dr. Levitin encouraged attendees to incorporate 10 to 15 minutes of mind-wandering a day while working in the Emergency Department (E.D.).
 
Decision Fatigue was the third major theme. Researchers have recently discovered a network of neurons that help people make decisions. The network does not distinguish between important and unimportant decisions. This information is valuable because it can help us govern the ways we schedule our brain power and make decisions during the day. He cited an example of judges, who in a recent study, were shown to make better decisions just after beginning work in the morning or right after lunch. The quality of their decision making declines as time passes between meals. So, if you’re innocent, you want a court case early in the morning or just after lunch. If you’re guilty, you want your case heard late in the afternoon. “Your mother was right,” Dr. Levitin said. “If you have an important decision to make, sleep on it and make it the next day.” He acknowledged that everyone has to make dozens of decisions each day. “But, you have the luxury to know that some decisions will be better than others, depending on the time of day. In some cases, it may be best to consult another colleague who is fresher regarding decisions that have to be made.”
 
The fourth major theme he highlighted was Externalizing Your Memory. “Writing things down reduces the burden of having to remember them,” he explained. “We tend to think our memories are better than they are. Memory is fallible, so it’s best to put things out in the world, so they don’t have to stay in your brain.” David Allen, an efficiency guru, says writing things down on note cards is a mind-clearing exercise. Studies have shown that people who write things down remember them better than those that type them. Use the environment to remind you of things you need to do. Set up a system to remind you where you put things – keys, wallet and/or telephone. Put a bowl by the door to provide a consistent location to place these items. If you check into a hotel room, experts recommend spreading a white hand towel out on a nightstand to designate a place to put your room key, wallet, phone, etc. Dr. Levitin described transactional memory systems as shared information structures. “People who are most effective and have the most power in organizations aren’t necessarily ones who know everything, but they do know the people to call to get the information. These people are extensions of memory because they help the other person keep track of all of the information.”

Managing Channels of Communication was the fifth major theme. “In this era of connectivity, we must figure out ways to manage how people reach us,” he said. “We have to train people in our social networks about how we want to be reached and when. There are truly a limited number of people who need to reach us immediately. Using a second email address for urgent communication is one way to manage contact. The worst thing to do first thing in the morning is to open up email. Every email requires us to make a decision. Before you’ve really done anything meaningful, you’ve already depleted your decision-making capacity.”
 
Dr. Levitin wrapped up his presentation with the sixth major theme – Ways to Handle Information Overload Better. “This really is the age of information overload,” he told the audience. “Every day of last year, Americans took in five times as much information as they did in all of 1986. That’s the equivalent of reading 175 newspapers cover to cover daily. In fact, we have created more information in the last four years than in all of human history before. Specialization has created a glut of information. Consider that last year 2,000 papers were published on the visual system of the squid. For every hour of YouTube video you watch, there are 12,000 additional hours of video being uploaded.”

How severe is the problem of overload and how does it exacerbate the number of decisions we have to make? In 1976, the average grocery store stocked 9,000 unique items. Today, more than 40,000 unique items populate grocery store shelves. Why is this important? Decision making has a neurobiological cost associated with it.
 
Bringing the topic back to the E.D., Dr. Levitin advised attendees to have a serious conversation about collaboration and record keeping. “We can talk faster than we can write,” he said. “Remember when physicians used the Dictaphone to capture their notes? Now we all have this capability on our smartphones. That’s why there has been an explosion of voice to data conversion programs. Developers are currently perfecting automated data entry into the patient record. No interruption zones are a great idea, as are mandatory short breaks that allow for mind wandering. Checklists provide an important avenue for externalizing memory. Examples include surgical checklists, palliative care checklists, medication administration checklists, etc. They reduce the stress of multi-tasking. Finally, I urge you to consider implanting gatekeepers – human or mechanical – to take extraneous calls and messages that create interruptions. These gatekeepers will protect your time and will help put into priority what will come into your sphere of decision making.”

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