Overhaul of staff is done 'right, not fast'
Process takes more than 6 months
Taking nearly seven months to transition from an ED staffing model of a contracted physician group to one that involved a partnership with a neighboring medical school might seem overly long, but the leadership at St. Joseph's Hospital in Buckhannon, WV, says they wanted to "do it right." That process included bringing on properly credentialed physicians, as well as doctors who would relate well with the surrounding community.
It also meant keeping the ED running smoothly from the time the previous group's contract expired until the new doctors were fully onboard, while at the same time continuing with process improvements that had been put in place.
That ambitious goal was achieved, says Amanda Jones, RN, BSN, the director of the ED. "Our rate of patients left without being seen has held steady at 1% for the past three years, and during the transition it held steady at that level or even below," Jones says.
"We have very high standards," Jones says. "In 2009 our average length of stay was 1.66 hours. This year it is at 2.07." High performance levels are maintained, she says, because when physicians are seen not performing at the desired speed, either Jones, the medical director, or the hospital CEO will speak with the physician in question. "And our nurses are very adamant that when a patient comes into a room, they do not wait for treatment," she adds.
When the decision was made in June 2009 to change from an ED management group to an external physician group, St. Joseph's chose the Department of Emergency Medicine at Charleston, WV-based West Virginia University (WVU).
"We worked toward a goal of a six- or seven-month period for the transition to be fully implemented," says Sue Johnson-Phillippe, RN, MS, FACHE, president and CEO of St. Joseph's. "We wanted to make sure we had the right physician providers in place we needed, not only in terms of numbers, but also credentials." In other words, all of the physicians had to be board certified in emergency medicine, Johnson-Phillippe says.
Jones says, "We never once discussed volume. It was more a case of a fit for the community. WVU is a major care center in rural West Virginia, and they already had physicians established within our community." The community's perception of WVU medicine is that it is "top of the line," so to bring them to St. Joseph's "is great for our patients," she says.
In terms of numbers, they did not really change. Pre- and post-transition physician staff was five FTEs, which could involve anywhere from seven to 12 doctors.
Integration of the new staff into the ED has been smooth, says Jones, "The nurses absolutely love them. They were well-picked, both by us and WVU," she says. In addition to Robert Blake, MD, who is a local physician, "We were lucky enough to be able to choose another doctor who was born and raised in our county," says Jones.
Johnson-Phillippe says the new physicians "can be very nice and gracious, but they also deliver quality care and the best outcomes possible."
ED fills the gap during transition
During the seven-month period when St. Joseph's Hospital in Buckhannon, WV, severed its relationship with an ED physician management group and formally began a new one with the Department of Emergency Medicine at West Virginia University (WVU) in Charleston, the department was kept running at full-speed without any drop in performance, according to ED and hospital leadership.
How did they do that? "In the beginning, we met about every other day," recalls Sue Johnson-Phillippe, RN, MS, FACHE, president and CEO of St. Joseph's. "Part of the strategy was that we employed a number of doctors to get us through and ended up using some [locum tenens staff].
In addition, without any guarantees a "carrot" was held in front of them: They might ultimately be employed by the university, says Johnson-Phillippe. "With that model we were able to use some senior residents from WVU, who also got exposed to our ED during the interim," she says.
The only physician from the previous staff who stayed was the long-time medical director, Robert Blake, MD, notes Amanda Jones, RN, BSN, the director of the ED. "He and I made it a point to either be in the department or to come in to see the new doctors when they arrived, to provide orientation, and give them time with the nurses," Jones says. The nurses "were more than willing to help any doctor adapt to our ED, and I and Dr. Blake were available pretty much 24/7 to make it work," she says. Many of the doctors who were able to come in and work a shift at a time eventually ended up with the department, she notes.
In addition, says Johnson-Phillippe, "The leadership for the department at WVU was intimately involved in seeing we were able to adequately staff the department. They did ongoing problem-solving with us when ran into a wall."
For example, ED managers from WVU would step in and take a shift if the St. Joseph's ED was short-staffed, Jones says.
For more information about staff transitions in the ED, contact:
Choose your triage staff very carefully
One of the most important staffing decisions you can make is who to assign to triage, because it can impact patient safety in more than one way, says Amanda Jones, RN, BSN, the director of the ED at St. Joseph's Hospital in Buckhannon, WV.
"Your strong clinical providers should be in triage," Jones says, and not just because it is critical to determine the urgency of each patient's condition. "Without that staffing, your ED can be backed up very quickly for virtually no reason," which in turn leads to longer waits and a greater risk of complications, she says.