Saturday, September 15, 2012

Revised ER management at JSMC has changed the culture

By Nick Tabor, New Era Senior Staff Writer
Jennie Stuart Medical Center has experienced hit-and-miss success with the doctor groups that have staffed its emergency room in years past.
At low points — including most of last year, Beth McCraw’s first year as vice president of nursing services — the phone rang continuously with complaint calls. Patients could wait all day for treatment for low-level emergencies, and about 9 percent walked off without getting treatment.
McCraw says Align MD, a Clarksville-based doctor group that took over around early March, has reversed the trend.
“It’s a totally different place down there,” she said Friday.

Her volume of complaint calls has dropped dramatically. When they do come in, Debra Flowers, who now oversees the emergency department’s nurses, returns the disgruntled patient’s call, she said.
Whereas patients with tooth aches or stubbed toes could wait eight or nine hours before, now they seldom wait more than two hours — three at the busiest times, Flowers said. Now only 2 or 3 percent leave without getting tnreatment, Flowers said.
Staff believe quality of treatment is also improving.
McCraw took her current position around the time Eric Lee became the hospital’s chief executive officer, in January 2011, she said. They identified the emergency department as one of four main areas they wanted to improve.
She describes it as the “front door of the hospital.” It sees an average of 100 to 130 patients a day, and many of them never see the rest of the facility. Moreover, patients’ general satisfaction correlates closely to satisfaction rates with the ER, she said.
All the ER’s nurses, including the nursing director, work for Jennie Stuart. But providers, including nurse-practitioners and the ER’s medical director, are contract employees from the physician company. Lee and McCraw wanted a medical director and nursing director who would work together smoothly.
The professionals they found — Flowers and Dr. Randall Ellis — had worked together for seven years at Centennial Medical Center in Nashville, according to a Jennie Stuart news release. It was the match Jennie Stuart wanted.
Dr. Mark Green, the president of Align MD, worked at Jennie Stuart’s ER years ago. His company now works with six hospitals in the southeastern U.S.
The ER relied heavily on part-time doctors in the past, including some who only worked their for single-day contract shifts, McCraw said. Now it has six full-time doctors who have moved here and committed to the area, Flowers said. Ellis said the department will hire two more.
Patients and nurses become more familiar with full-time doctors, Flowers said. McCraw said the doctors now send her frequent emails and text messages with ideas for tweaking hospital practices.
“They truly do care,” McCraw said. “What I hear is the compassion that’s in the providers. (Patients) haven’t seen that before.”
Ellis is becoming the medical director of Christian County’s emergency medical services, which helps improve communication with ambulance services, he said. And the ER is communicating better with Convenient Care at Jennie Stuart, sending more patients there for non-emergency treatment.
The staff has reevaluated its airway equipment and its protocol for treating heart attacks and strokes, Ellis said.
“We’re trying to improve quality while also improving the patient experience,” Ellis said. “My thought was always, if you’re not providing quality care, it doesn’t matter how fast you move them in and out.”
The ER treated slightly more than 32,000 patients last year, Flowers said. She expects a final count for this year between 35,000 and 36,000, though she suspects there are other factors besides the ER’s improvement, such as changes in the uninsured rate.
For more information on the Align MD, visit its website at

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