CAREER ACLS A dvance your C areer L ongevity and S atisfaction

1. CAREER ACLSAdvance your Career Longevity and Satisfaction Angela Siler Fisher, MD, FACEP Associate Chief for Operations and Public Affairs, Baylor College of Medicine Medical Director, Ben Taub General Hospital Emergency Center

2. Objectives A- Always satisfy. Patient Satisfaction. B- Be Safe. Patient Safety and Risk Management. C- Communication and Negotiation. D- Disposition efficiently. E- Excel in your career.

3. What’s in it for you?? (WIIFY) • Hard work?? • Everyday is an interview for your next job • Every group wants to hire the resident sought after by their own program • Who wants to be average?? • Average job, average life with average number of lawsuits??

4. A-Always Satisfy. Patient Satisfaction.

5. Are Patients our Customers? • Business model • You will be hired and fired on Patient Satisfaction • Golden Rule: “Patients do not remember all of what we say but they always remember how we made them feel

6. 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??

7. Time Mapping • Explain 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

8. Patient Satisfaction Tips • Make the customer service diagnosis • CP=MI • Cough=Lung CA • Address all concerns • Work note • Transportation

9. 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

10. Number 1 Reason to do Customer Service in the ED: • It makes your job EASIER • Less stress • Less liability • Patients more complaint • It makes your Administrators happy too! • More volume • More Money

11. 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)

12. B-Be safe.Patient Safety and Risk Management.

13. Patient Safety and Risk Management • Believe 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!!

14. 80-10-10

15. Clinical Decision Making • 80% History • 10% Physical Exam • 10% Diagnostics

16. Patient Safety and Risk Management • Don’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.

17. High Risk Cases • Return patients • Psychiatric patients • Sign-out

18. C-Communication and Negotiation.

19. Be an Effective Negotiator • Separate the people from the problem • Focus on interest, not your position • Use “I” Statements • Active Listening • The power of “Yes” • Work together to create options that will satisfy both parties

20. Communicating Concerns: • Culture of blame versus systems error • Don’t just complain—OFFER SOLUTIONS!! • Fundamental belief that everyone is doing their very best • No one is out to get you • Everyone is here to do what is best for the patient

21. Other Ideas to Try: • Handle complaints by using the “LAST” Technique • Listen • Apologize • Specify • Thanks • 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!”

22. D-Disposition efficiently.Efficient Practice

23. The Challenge • After initial evaluation of the ED patient, be able to identify: • Know who the sick patients are • Focused differential diagnosis • Appropriate diagnostic work-up • Implement initial management • Disposition

24. Patient Evaluation SICK NOT SICK Admit Early Consult • Normal vital signs • Eat/Drink • Pain management • ADL’s • Appropriate Follow-up No Yes DISCHARGE

25. Coding and Billing • Know documentation requirements and E&M levels • Know your RVUs/hr and how you compare to your peers • Expected productivity: • Medical Students: 0.5 patients per hour • PGY-1: 1 patient per hour • PGY-2: 1.5 patients per hour • PGY-3: 2 patients per hour

26. E-Excel in your career.Career Satisfaction and Wellness

27. Become a well rounded emergency physician- The Triple Threat

28. Credibility is a MUST! • Honor • Integrity • Trust

29. Challenges facing Leaders in EM • Boarding / overcrowding • Healthcare Reform • On-call specialists • Reimbursement • EMTALA • HIPPA

30. Wellness • Your career is only one aspect of your identity • You can’t grow as a person if you neglect your personal needs and your family/ friends

31. Know Thyself: • Fatigue • Illness • Family Issues • Money Problems • Relationships • Competence

32. Become a leader: Leadership Opportunities • Get Involved • Medical School/ Hospital • Specialty Societies • ACEP, EMRA, SAEM, AAEM, ABEM • State • TMA, County Medical Society • National • AMA • Let the best job find you through networking

33. Questions??