Angela Siler Fisher, MD, FACEPAssociate Chief for Operations and

Public Affairs, Baylor College of Medicine

Medical Director, Ben Taub General Hospital Emergency Center

ObjectivesA- Always satisfy. Patient Satisfaction.B- Be Safe. Patient Safety and Risk

Management.C- Communication and Negotiation.D- Disposition efficiently.E- Excel in your career.

What’s in it for you?? (WIIFY)Hard work??

Everyday is an interview for your next jobEvery group wants to hire the resident sought

after by their own programWho wants to be average??

Average job, average life with average number of lawsuits??

Are Patients our Customers?Business modelYou will be hired and fired on Patient

SatisfactionGolden Rule: “Patients do not remember

all of what we say but they always remember how we made them feel

Patient Satisfaction Tips Under promise—over deliver

This helps with wait time perception Assess and manage patient and family

expectations Does the patient expect admission or tests??

Time MappingExplain your focused differential, planned

management, diagnostic tests and the anticipated length of stay

Take the extra time to ensure that your patient agrees with your plan of treatment—it will save you time in planning disposition!!

Discussions should optimally include all family/friends

Patient Satisfaction TipsMake the customer service diagnosis

CP=MICough=Lung CA

Address all concernsWork noteTransportation

Staff Satisfaction• Communicate with staff regarding

pending tests and anticipated disposition

• No unnecessary double dipping• Manage/Talk up your staff• Be Human, Humble, Empathetic and

Polite/ Respectful

Number 1 Reason to do Customer Service in the ED:

It makes your job EASIERLess stressLess liabilityPatients more complaint

It makes your Administrators happy too!More volumeMore Money

Customer Service is a Skill Set much like ACLS/PALS, but it applies to Many More Patient Encounters!

(and it can help save/ resuscitate your career)

Patient Safety and Risk ManagementBelieve your patients—don’t minimize

or rationalize their complaints!!Always suspect the worst!!!No Gold stars for sending home sick

patients!!A patient that returns a second time with

a similar complaint deserves a much closer evaluation!!

Clinical Decision Making80% History10% Physical Exam10% Diagnostics

Patient Safety and Risk ManagementDon’t be fooled by the triage level

or area of evaluation!!Doing the right thing for your patient will

always ensure that physicians are rewarded.

Always document pertinent positives and negatives in your history and physical.

High Risk CasesReturn patientsPsychiatric patientsSign-out

Be an Effective NegotiatorSeparate the people from the problemFocus on interest, not your positionUse “I” StatementsActive ListeningThe power of “Yes”Work together to create options that will

satisfy both parties

Communicating Concerns:Culture of blame versus systems errorDon’t just complain—OFFER

SOLUTIONS!! Fundamental belief that everyone is doing

their very bestNo one is out to get youEveryone is here to do what is best for the

patient

Other Ideas to Try:Handle complaints by using the “LAST”

TechniqueListenApologizeSpecifyThanks

Use Scripts “My goal is to control your pain, so you let me

know how we are doing!”“Come back any time- we never close!”

The ChallengeAfter initial evaluation of the ED patient,

be able to identify:Know who the sick patients areFocused differential diagnosisAppropriate diagnostic work-upImplement initial managementDisposition

No

Yes

Patient Evaluation

SICK NOT SICK

Admit

Early Consult

– Normal vital signs

– Eat/Drink

– Pain management

– ADL’s

– Appropriate Follow-upDISCHARGE

Coding and BillingKnow documentation requirements and E&M

levelsKnow your RVUs/hr and how you compare to

your peersExpected productivity:

Medical Students: 0.5 patients per hourPGY-1: 1 patient per hourPGY-2: 1.5 patients per hourPGY-3: 2 patients per hour

Become a well rounded emergency physician- The Triple Threat

Credibility is a MUST!Honor Integrity Trust

Challenges facing Leaders in EMBoarding / overcrowdingHealthcare ReformOn-call specialistsReimbursementEMTALAHIPPA

WellnessYour career is only one aspect of your

identityYou can’t grow as a person if you neglect

your personal needs and your family/ friends

Know Thyself:FatigueIllnessFamily IssuesMoney ProblemsRelationshipsCompetence

Become a leader: Leadership OpportunitiesGet Involved

Medical School/ HospitalSpecialty Societies

ACEP, EMRA, SAEM, AAEM, ABEMState

TMA, County Medical SocietyNational

AMALet the best job find you through networking