SHAPING THE ED FOR EDUCATION - ALIGNING GOALS Michael Gibbs, MD Chair, Carolinas Medical Center Megan Fix, MD Associate Program Director, University of Utah Why is this important? History of resident education and hospital administration Values now more aligned Patient satisfaction, RVUs, EHR, etc Goal - to train physicians who are effective in their careers Need synergy and collaboration to make this work Aligning Goals 1
Literature Electronic Health Record Good, bad, ugly for education Staffing models Residents, mid-levels, triage models 2
A few words on the EHR Milestone 18 - SBP 3 all about EHR HITECH - Health Information Technology for Economic and Clinical Health 3
12% of time in direct patient care 64% in indirect patient care 15% educational activities computer use occupied 40% of their time 4
SURVEY TO CORD AND CHAIR LISTSERVES 5
Defining the problem Please rank the impact of each factor 0 = no impact 1 = small impact 2 = moderate impact 3 = major threat to resident education Defining Issues - PDs Time Spent with electronic documentation RVU Based physician compensation model Increased attn on patient throughput and ED LOS Increased emphasis on patient satisfaction Financial Pressures ED Overcrowding Increased burden of faculty admin responsibilities ED Design and staffing models Defining Issues - Chairs Time Spent with electronic documentation RVU Based physician compensation model Increased attn on patient throughput and ED LOS Increased emphasis on patient satisfaction Financial Pressures ED Overcrowding Increased burden of faculty admin responsibilities ED Design and staffing models 6
MOST IMPACTFUL FACTOR FOR PD Time spent with electronic documentation 2 MOST IMPACTFUL FACTORS FOR PD Time spent with electronic documentation Increasing burden of faculty administrative responsibilities MOST IMPACTFUL FACTOR FOR CHAIRS Time spent with electronic documentation 7
2 MOST IMPACTFUL FACTORS FOR CHAIRS Time spent with electronic documentation Financial Pressures Solutions PD Solutions - Categories Initiatives to: Promote and reward superior education by faculty Facilitate education in the ED Enhance resident knowledge of ED operations, billing and performance 8
Initiatives To Promote And Reward Superior Education By Faculty Incentive compensation that includes metrics directly related to teaching and research Highly transparent reward system for academics: clear expectations and chair buy in Support teaching & research Initiatives To Facilitate Education In The Emergency Department Scribes Hiring highly motivated and gifted clinical faculty Introduction of a Teaching Attending with duties dedicated to daily case presentations and the supervision of medical students Hiring mid-levels to staff ED during conference Double attending coverage during before conference PD Comments - Staffing models Provider at Triage Attending only areas of department to unburden resident teams Midlevel providers or attendings in fast-track areas w/o residents Mirror staffing for patient volume Overlapping shifts Transitional care unit where stable admitted patients go 9
Enhance Resident Knowledge Of ED Operations And Performance Education on patient satisfaction, documentation, coding, EMR, reimbursement Resident involvement on committees addressing ED operations and throughput Residents involvement with quality projects Chair Solutions - Categories Initiatives To: Promote and reward superior education by faculty Facilitate education in the ED Enhance resident knowledge of ED operations, billing and performance Initiatives To Promote And Reward Superior Education By Faculty Incentive compensation that includes metrics directly related to teaching and research Highly transparent reward system for academics Fund-raising to support teaching & research 10
Initiatives To Facilitate Education In The Emergency Department Provider at Triage Scribes Increased number of volunteer faculty Hiring highly motivated and gifted clinical faculty Introduction of a Teaching Attending with duties dedicated to daily case presentations and the supervision of medical students Enhance Resident Knowledge Of ED Operations And Performance Education on documentation, coding, EMR, reimbursement Resident involvement on committees addressing ED operations and throughput Residents involvement with quality projects LOOKING AHEAD Experience at Carolinas Medical Center to address these concerns 11
SOLUTIONS Ideas to take back to your home institutions 12