1. 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??

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)

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

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!”

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. No Yes Patient Evaluation SICKNOT SICK Admit Early Consult –Normal vital signs –Eat/Drink –Pain management –ADL’s –Appropriate Follow-up 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

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

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