Part 2 of the Milford Patient Family Advisory Council story: Results and Reflections

In Part 1, Beverly Swymer told the story of how the Patient Family Advisory Council of Milford Regional Medical Center improved care in the Emergency Room for behavioral health patients.

As Part 2, here are my thoughts on their results, and their ingredients of success. –Ken Farbstein

This effort reduced E.R. recidivism by 82% among a group of behavioral health patients who had frequently used Milford’s E.R. (from 7.3 visits/patient to 1.3, n=12 patients over the period of four months before, and four months after, these changes took effect).  This was probably particularly helpful in freeing E.R. capacity because the number of behavioral health E.R. visits at Milford had been growing about 7% each year.  

In interviewing Beverly, I had urged her to elaborate on her role, and I was puzzled at the absence of “I” in her answers. We often preach about the importance of collaborative styles, but rarely see them in practice.  I came to realize that I was hearing from a genuinely collaborative, self-effacing leader.  Beverly served on the PFAC after her long career at Milford as a nurse ended in 2009.  Her leadership style, or indeed her nature, along with her acquaintance with many of the staff, and the active participation of staff including the Chair of Emergency Medicine, helped to bring about these solid accomplishments.  

When I asked bluntly about her own role and contribution, she answered wisely, in a way that might sound clichéd in someone else’s mouth:  “It’s very important to make people feel empowered, to impact the journey, to think this will come about if we work on this together, like we did with rounds in the E.R.  The PFAC was a vehicle to come together to see what we could do to make a difference, and we did make a difference.”

Read about other accomplishments of Milford Regional's PFAC.  Thanks to Terri McDonald, Kim Munto, and Beverly Swymer for these stories.

The value of a scribe: The patient's care was expedited

Fabio Giraldo is a Scribe with ScribeAmerica.  This is his story:

I was working a night shift in a single-coverage Emergency Room and I happened to be floor training as well. It was a busy night and the E.R. was gridlocked, and patients were starting to pile up in the waiting room. It was common for the triage nurse to place orders to get things started under the attending physician's name when the waiting room started filling up, and this night was no different. Being that the E.R. was gridlocked and we were not seeing any new patients, I took this opportunity to show the trainee how to look up X-rays on the PACS system.  I also started to explain to the trainee that it was important to monitor the waiting room results, being that the physician we were working with was the only physician on, and all of these [X-ray] studies were being ordered under his name.

As the apprentice scribe started pulling up images from patients in the waiting room, I heard him say "Wow!  This X-ray looks really weird."  I looked over to the PACS station and noticed this patient had free air under the right hemi-diaphragm, a finding that is consistent with a bowel perforation [a hole all the way through the wall of the intestine, which causes bacterial contamination of the abdominal cavity or peritonitis, a painful dangerous infection of its lining].  I immediately had my physician look at the X-ray.  He agreed and immediately called the surgeon on call, who took the patient to the Operating Room.

Approximately 30 minutes after the patient was taken to the O.R. my physician received a phone call from Radiology to notify him that one of his patients was found to have a bowel perforation on X-ray.  Because the apprentice scribe was vigilant to the orders placed in the waiting room, this patient's care was expedited and they were already in the O.R. by the time the Radiologist called the E.R.  [The prompt treatment of peritonitis can prevent complications, according to Freed's Medical Dictionary.]

Thanks to Fabio, and to Michelle Thompson of CWR & Partners for connecting us.  Read another story of how one very different medical practice has a technician serve as scribe, enabling the prompt preparation of a visit summary.