EmCare Clinician Blog

Current Articles | RSS Feed RSS Feed

In Case You Missed It: Week of Oct. 3, 2014


“In Case You Missed It” is a weekly roundup of popular healthcare headlines.icymi

[Ebola Update] VIDEO: Family of Ebola Patient Quarantined.

ACEP Disagrees with EM Residency Survey Method Used by US News & World Report. ACEP and the leaders of other medical specialties representing emergency medicine, have taken issue with a recent survey of emergency medicine residency programs ...>>

[Research Article] Factors Associated with Overcrowded Emergency Rooms in Thailand: A Medical School Setting. Read the entire article here.

[SLIDESHARE] How to Create a High-Performance Healthcare Organization. What strategies are in your arsenal to combat and conquer the thorny challenges of healthcare reform? 

Join us at these upcoming events!

emcare events

Visit us at these upcoming conferences!

10/11: Anesthesiology 2014 Booth 2136

10/12: ACOEP-The Edge Booth 36

10/27: ACEP 2014 Booth 1611 

View all upcoming events!







5 Reason to get a flu shot + The Viral Flu Shot Video You Need to Watch Now


It is officially the best time to get your flu shot. If you’re on the fence about getting the fluFlu Shot Graphic shot, our Divisional Director of Clinical Services, Denise Sexton, RN, BSN, has written up the five best reasons to give it a shot! And, after the tips, click the link below to see one brave little girl who shows you how to conquer the flu shot.

5 Reasons to get a Flu Shot

  1. Getting a flu vaccine can reduce physician visits and insurance claims by up to 44%. This decreases the risk of spreading the flu to patients going to physicians for other reasons. This also decreases unnecessary visit to the emergency department.
  2. To prevent complications from the flu. Flu can turn into pneumonia especially if someone has respiratory problems or who has a weakened immune system. This also includes people 65 years of age and older or people of any age with chronic medical conditions such as diabetes, asthma, heart disease, pregnant women and children. Influenza is the most frequent cause of death in a vaccine preventable disease. Each year more than 200,000 people are hospitalized from flu-related complications and about 36,000 people die of complications of the flu in the US. Of these people 90 percent of the deaths occur in people 65 or older.  
  3. Loss of hours worked. You may lose 5-7 days of work if you become ill with the flu and do not suffer any secondary infections from the flu which could cause you to be off from work even longer. CDC states there can be up to a 45% reduction in lost workdays by being vaccinated.
  4. Prevent spreading illness to your children and family at home. You can be infectious to others up to a day before you show any symptoms.
  5. Prevent spreading illness to the patients you are caring for and/or coworkers. This can reduce morbidity and mortality for patients who are at risk when in the hospital and cause coworkers to miss days at work or spread the illness to their friends or family.

Click here to watch the latest viral video of one child’s reaction to getting the flu shot.

BONUS: If you think you know all there is to know about the flu take the Flu IQ Quiz at  www.cdc.gov/flu/fluiq.htm


describe the imageDenise Sexton o­ffers 20 years of healthcare experience to EmCare partner hospitals, and over 15 years specifically in the emergency department and in leadership roles. As a Divisional Director of Clinical Services for EmCare, Denise’s strength in leadership and diverse clinical skills provides a solid foundation for improving hospital operations, not only in the E.D, but also with services including hospitalist programs, observation units, operating rooms and critical care units. Denise uses her education and experience to o­ffer expertise and broad perspectives for E.D. and inpatient managers.


I was a victim of violence in the E.D. Here's my story. Pt. 1

Clinical Hot Topics: ABC Principle of Change


Hosted by Al Sacchetti, MD, FACEP as moderator, Don’t Blink or You Will Miss It - Clinical Hot Topics can feel much like the “speed dating” of training presentations. The 12 hyper-paced presentations covered a wealth of information for the 2014 EmCare Leadership Conference attendees.  Each week, we’ll publish highlights from select clinical hot topics presented at the conference.

By Maureen Leckie, MSN, RN, Associate Vice President of Clinical Operations and Aprilhot topics Novotny, MSN, RN, CEN, Director of Emergency Services at Lakeland Regional Medical Center

Lakeland Regional Medical Center has experienced a transformation in efficiency, attitude and culture that is worthy of imitation. Change starts with a vision. “If you see it, you can find a way to get there!” It is propelled with communication that explains the need for change, expectations, and goals. It is nurtured with support and guidance.

The team summed it up in the “ABC principle of change” that requires: Accountability; Benchmarking Data; and Communication and Collaboration.

Want to get started?

Start by asking those on the front line to describe each process “in a perfect world.” This will help you understand the challenges and barriers to the change you are requesting. Then, monitor and provide frequent positive feedback regarding their compliance with new expectations until they become routine

For Lakeland Regional Medical Center, the changed culture resulted in a 2014 Gallup Great Workplace Award and a waiting list for ED RN applicants. The average turnaround time is now two hours 10 minutes. The number of patients who have Left Without Being Seen is less than two percent. And all this while the hospital that has seen exponential growth and an all-time high volume of 668 patients in one day.


EmCare’s Genesis Cup Honors Innovation, Creativity in Healthcare

Get to Know our September Clinician of the Month: Dr. Matthew Carrick


EmCare has more than 10,000 clinicians serving communities across the country and we want to share their stories with you. Get to know these hard-working, difference-makers right here with our monthly “Clinician of the Month” blog post. Do you know a clinician who should be featured? Email socialmedia@emcare.com!


Dr. Matthew Carrick is the Site Medical Director for The Medical Center of Plano in Plano TX.
This shining account of Dr. Carrick’s character and professionalism was written by EmCare’s Acute Care Surgery CEO, Dr. John Josephs.

Matt Carrick not only exemplifies the mission of EmCare through superior physician service but embodies the characteristics of a true visionary and leader within the Acute Care Surgery organization.

One of Matt’s many demonstrations of compassion is his tremendous ability to communicate with establishing patient and family trust during difficult situations.  By demonstrating his character to patients and family, he has instilled in the nurses, fellow physicians and staff this same character which has impacted significantly the rate of organ donation at The Medical Center of Plano.  This particular element of his character and ability to collaborate with the entire medical staff has driven the Acute Care Surgery Trauma Team at The Medical Center of Plano to advance the end of life patient care management as well as impact the community and the lives of others through increasing the availability of viable organs for donation.  Through his leadership The Medical Center of Plano has become the leading facility for organ donation in the Region even though by volume they are not the highest volume or acuity facility.

Matt graciously extends his service beyond his physician-patient scope of practice to one of leadership and collaboration with the entire medical director team within Acute Care Surgery.  As Acute Care Surgery has expanded its service to institutions across the nation, Matt has been instrumental in offering a front-line perspective to other hospitals seeking trauma designation. 

He also serves as a mentor and a resource to both our seasoned professionals and our aspiring future physician leaders.


Family Squabbles Can Derail Recovery From Cancer Surgery

Researchers note infection, other complications more likely for patients with difficult lives 

FRIDAY, Sept. 19, 2014 (HealthDay News) -- Cancer patients burdened by stress and family conflicts before surgery may face a higher risk for complications following their operation, according to a study published in a recent issue of the Journal of Gastrointestinal Surgery.

The findings were based on 431 colon cancer patients who underwent surgery in 1993. Patient surveys ranked quality of life on the basis of a wide range of physical, social and psychological measures, including pain, fatigue and nausea, as well as "distress" related to daily routines, the work environment, and interactions with family and friends.

The research team found that nearly one in five patients experienced some type of complication, including death in two cases, before hospital discharge. Thirteen percent of patients had a preoperative quality of life score of less than 50 on a scale of 100. That translated into a 16 percent risk for developing a serious complication while still in the hospital. By comparison, those with better quality-of-life scores faced a complication risk of 6 percent.

"The situation is very individual for each patient. And other factors can play a major role in complication risk, such as a patient's age or the presence of other diseases," study lead author Juliane Bingener, M.D., a professor of surgery at the Mayo Clinic in Rochester, Minn., told HealthDay. "But all things being equal, there was a very clear correlation between a poor quality of life and a higher risk for problems following surgery."

Full Article
Full Text (subscription or payment may be required)


Recent Increase in Liver Injury From Herbs, Supplements

Liver injury from nonbodybuilding supplements more severe than from bodybuilding supplements, meds

FRIDAY, Sept. 19, 2014 (HealthDay News) -- The proportion of liver injury cases resulting from herbals and dietary supplements (HDS) has increased significantly in the last decade, according to a study published online Aug. 25 in Hepatology.

Victor J. Navarro, M.D., from the Einstein Medical Center in Philadelphia, and colleagues characterized hepatotoxicity and its outcomes from HDS versus medications. The study included 839 consecutive patients seen for liver injury at eight U.S. referral centers from 2004 to 2013. Cases were stratified according to the type of agent implicated in liver injury.

The researchers found that 45 cases were caused by bodybuilding HDS, 85 by nonbodybuilding HDS, and 709 by medications. Over the study period, there was an increase in liver injury caused by HDS, from 7 to 20 percent (P < 0.001). In young men, bodybuilding HDS caused prolonged jaundice (median, 91 days), although there were no fatalities or liver transplants. Compared with injury from medications, the remaining HDS cases presented as hepatocellular injury, predominantly in middle-aged women, and more often led to death or transplantation (13 versus 3 percent; P < 0.05).

"The proportion of liver injury cases attributed to HDS in DILIN [Drug-Induced Liver Injury Network] has increased significantly," conclude the authors.

Several authors disclosed financial ties to the pharmaceutical industry.

Full Text (subscription or payment may be required)


Presence of Peers Ups Health Workers' Hand Hygiene

But, as social environment becomes more crowded, marginal returns diminish

FRIDAY, Sept. 19, 2014 (HealthDay News) -- The presence of other health care workers improves hand hygiene adherence, according to a study published in the October issue of Infection Control and Hospital Epidemiology.

Mauricio N. Monsalve, from the University of Iowa in Iowa City, and colleagues deployed a custom-built, automated, hand hygiene monitoring system to detect whether a health care worker practiced hand hygiene upon entering and exiting a patient's room. The system also estimated the location of other health care workers with respect to health care workers entering or exiting a room. During a 10-day study period, 47,694 in-room and out-of-room hand hygiene opportunities were analyzed.

The researchers found that the observed adherence rate was 20.85 percent when a worker was alone (no recent health care worker contacts). However, the observed adherence was higher (27.90 percent; P < 0.01) when other health care workers were present. The number of nearby health care workers correlated with increased adherence, but at a decreasing rate. After controlling for confounding factors, these results were consistent at different times of day and for different measures of social context.

"The presence and proximity of other health care workers is associated with higher hand hygiene rates," the authors write. "Our results also indicate that rates increase as the social environment becomes more crowded, but with diminishing marginal returns."

Full Text


In Case You Missed It: Week of Sept. 26, 2014


“In Case You Missed It” is a weekly roundup of popular healthcare headlines.

Does Provider Dress Code Impact Patient Experience? Physician attire and appearance isPit Crew CPR an area that many organizations discuss and, in some cases, struggle to define. Read more: http://ow.ly/BVvk0  

Clinical Hot Topics-Pit Crew CPRDuring complex, high-intensity processes, even simple activities can be difficult. That's why Dr. Howie Mell recommends the three P’s for success.

When a doctor lands in the ER with a tube down his throat, he learns a thing or two. This doctor gets a new perspective when he's on the other side of the stethoscope in this Washington Post article.

The Things We Say to our Patients that We Should be More Tactful About. With the increased focus on patient satisfaction and improving the healthcare experience, how we communicate with our patients is becoming more important than ever. Read more at HospitalMedicine.org.

Ebola Death Toll Is More Than 2,900, W.H.O. Says: Here's the latest news on the Ebola outbreak.

Doctors Need More Quiet Time. Dr. Wes Fisher shares his views on setting boundaries in the hospital in this post on KevinMD.com.

Join us at these upcoming events!

emcare events

10/2: Emergency Ultrasound Consultants and EmCare present the Ultimate Ultrasound Course.  This one day agenda, features an introduction to Emergency Ultrasound scanning that exceeds ACEP criteria. Click here for details.

Visit us at these upcoming conferences!

9/30: TCAA 17th Annual Conference

10/11: Anesthesiology 2014 Booth 2136

10/12: ACOEP-The Edge Booth 36

10/27: ACEP 2014 Booth 1611 

View all upcoming events!




Studer Spotlight: Does Provider Dress Code Impact Patient Experience?


Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com


By: Dan Smith, MD, FACEP

Copyright 2014 by Studer Group, reprinted with permission.

Physician attire and appearance is an area that many organizations discuss and, indan smith some cases, struggle to define. Several factors come into play such as, variations in appearance, generational differences, business casual as commonplace, organizational branding without being overbearing on individuality and so on.

Although more commonly deployed for staff and non-physician positions, dress and attire standards are not a new concept. We find that many organizations have moved to uniform color codes for ease of identification of certain staff positions and have adapted stricter guidelines around dress code, including covering of tattoos.

The literature also suggests that this topic is being addressed across the industry. The common theme is professionalism. One Emergency Medicine study found that formal attire vs. scrubs was not associated with a significant difference in patient satisfaction or perception of professionalism. Another study published in an Archives Internal Medicine article suggests that certain physician appearances conjured "negative" perception.

Patients look for physician appearance to be one that garners trust and assuredness. As an example, a surgeon who meets a patient at surgical clinic with clean, ironed, hospital-issue scrubs is perceived as professional and dress-appropriate. Why? Because a patient associates a surgeon in their professional work attire, which often times include scrubs. On the other hand, a surgeon in fashion-distressed jeans and an open collar shirt with psychedelic design might be perceived as too casual to an anxious patient who faces a major surgery.

Let's say that a provider says, "I don't care about the patient's preference of my appearance or attire". But what if the doctor knew that their appearance and attire might alter a patient's perception, particularly in a negative way? What if we were aligned and committed enough to an organization that we put our individual preferences on hold during the care hours? What if the patient's anxiety reduced when they saw a professional-appearing physician who exuded confidence? What if uniform dress reflected "team", "collaboration" and reduction of variance? That is the essence of dress code.

My thoughts and coaching on this as a practicing physician are as follows:

  1. Patients are the focus of what we do in healthcare. I am more than willing to be professionally dressed if it helps my patient have a better experience under my care.
  2. We are professionals in a high stakes, high impact arena. Patient opinion and perception of professionalism should guide our approach.

I would say, though, that we don't want a "cookie-cutter" mandate, like male physician hair parted from the left to the right, hair 1 cm above ear and Johnston-Murphy loafers only! My feeling is what we do in healthcare holds us to a higher standard. The precise dress code and attire your practice embraces is a decision that each group must make and embrace. I hope this content helps you make an informed decision.

Physician engagement and buy-in is an important step to ensuring everyone is on board with changes in policy, such as new physician attire and appearance. Several resources that can assist include:

My colleagues, Doctors Stephen Beeson and Jay Kaplan also discuss the importance of aligned, engaged and fully integrated physicians during Studer Group’s Physician Partnership institute. Attendees gain the tools, tactics, behaviors, and best practices that are proven to increase physician satisfaction, improve patient compliance and gain market share through a collaborative partnership with physicians. Click here to learn more.


  • The Journal of Emergency Medicine, Vol. 29, No. 1, pp.1-3, 2005
  • Gjerdingen, Simpson, Titus, Patients’ and Physicians Attitudes Regarding the Physician’s Professional Appearance. Arch Intern Med. 1987; 147(7): 1209-1212.

Clinical Hot Topics: “Pit Crew” CPR


Hosted by Al Sacchetti, MD, FACEP as moderator, Don’t Blink or You Will Miss It - Clinical Hot Topics can feel much like the “speed dating” of training presentations. The 12 hyper-paced presentations covered a wealth of information for the 2014 EmCare Leadership Conference attendees.  Each week, we’ll publish highlights from select clinical hot topics presented at the conference.

By Howard Mell, MD, MPH, CPE

Dr. Mell

During complex, high-intensity processes, even simple activities can be difficult. Participants have little to no concept of time and limited ability to synchronize and time tasks. So any necessary interruptions should be engineered and linked activities heavily choreographed to minimize the impact from a loss of temporal awareness. Dr. Mell recommended the three P’s:

                PREPARE - set up equipment for ease of use

                PLAN - define and assign roles, set up contingencies

                PRACTICE - you can’t set this up “on the fly”


                These three steps can help achieve high-performance under high-pressure.

All Posts