Jeremy Essman's Profile

I agree this is a problem. Here are a few things we are currently doing with some success. To start, our medical staff changed the rules and allowed different categories of membership. If you are a primary care provider who doesn’t come to the hospital any longer but still part of the system, you can stay active with a nominal fee but not required to have all the annual requirements to be a full time member. This will allow you to receive updates from the health system and attend our quarterly medical staff meetings. Secondly, we began utilizing our business development team to meet with our specialists and PCPs in the community. They aren’t necessarily part of our health system but refer their patients to our facility. When issues arise, we send out someone from administration along with medical director of the hospitalist. We try to correct the problem immediately which the PCPs then feel involved. Lastly, our specialists constantly go to community events to educate other specialists and PCPs about the latest technology and how we can partner to deliver better care.

The dreaded EHR. We are currently going through this process as well. I am not sure what options you have but this is how we tackled the situation. This became physician led with multiple different groups. For instance, one grouped was designed to achieve feedback in the ambulatory world, and then grouped specialties on the inpatient side. As we all know, different needs would need to be met with the different groups. Our EHR leaders took the feedback quite seriously. They were able to design the login page to meet the demands the different specialties requested. On the back end, the data was centralized. We are staggering the rollout of the new platform so we don’t overwhelm the system. This also gives our team a chance to address the issues that we didn’t realize and correct before the next rollout phase. The entire process is going to take two years. So far we still have full engagement from the physicians and not too much push back. Good luck!

We were having a similar issue. Within the hospital we were also having issues with incorrect medication/dosage being written. This occurred since the medication history was being completed by an ER nurse who many times did not verify if changes had occurred with medications. To tackle this problem we grouped both issues together. Patients admitted through the ED, we hired pharmacy technicians who completed all medication histories. Therefore, when the physician completed the medication reconciliation, we knew we had 100% accuracy with medications. Once the patient was admitted, we offered prescriptions to be filled at our in-house pharmacy with a discounted rate. This occurred about 75% of the time and allowed “meds to beds” with ease. The remainder 25% had prescriptions sent prior to discharge which allowed a “check and balance” with pharmacy to be sure the medications were accurate and any teaching on how to take the medications. Our compliance rate greatly improved.

The dreaded temperature monitoring. This was killing us in terms of being compliant with DNV. Our institution continuously had non-conformities in this area. Three years ago we changed to centralized monitoring. We were also concerned with front end staff ignoring the alerts. To tackle the issue, we elected to utilize our plant operations team. The centralized monitoring is located in a secure area within plant operations. Since we need to have someone from plant ops on location 24/7, any temp out of range is alerted both to centralized monitors as well as the cell phone the person carries. Majority of the time it is a faulty alarm and can be reset from the centralized monitors. However, if the alert is true, each department has their manager that is on-call and will be alerted by the plant operations member. For the last three years, we have had no write ups from DNV and no incidents have occurred. Good luck!

There have been trends of this occurring through some parts of the country lately. I believe with Physician shortages, the push to have more PA/NPs to fill voids has increased. What I have noticed, with more Advance Practice Providers (APP), most organizations have not included their representation at the leadership levels. Most organizations have more or less dictated the type of work, where to work, schedules, and how to perform their duties without including this group in decision making. We had a similar problem a few years ago. Our institution began making the change by adding one PA/NP to each of the medical executive committees with voting rights. Within the medical groups, each designated a leader that was either an NP or PA. In addition, we started APP grand rounds at the hospital which gave the APPs a chance to get CME, lunch, and discuss issues collectively as a group. Over time, the engagement began to change and the APPs took “ownership” of many issues. We aren’t perfect, however, we have noticed changes within the organization.