A Dynamic Duo

Emergency Departments were created in hospitals in the early twentieth century as a place where accident victims or the seriously ill could be brought for rapid assessment and treatment. Over the course of the twentieth century they became much more than that, and are now a place where patients are often sent or come on their own because their needs cannot be met elsewhere. If a physician's office or clinic is closed, or if it is determined that another patient can't be accommodated in the office, the patient is sent to the ED. If a patient needs to be admitted, but there are no available beds on the floor, the patient is sent to the Emergency Department. If you have no doctor (or no insurance) but you need help, even if the issue is not an emergency, you go to the ED. The Emergency Department is the pathway of least resistance in our complex healthcare world.

So it is easy to understand why the ED is a very busy, frequently over-crowded place and why it can be a very difficult place to work. I am very proud of the people that staff our Emergency Department at GBMC. They do great work and they have made incredible progress at redesigning the processes that they control, all towards the goal of making it better for our patients. From the nurse in triage, to the registration staff, to the nurses, physicians, and other clinicians and staff providing the care and maintaining the rooms, the whole Team has been in action making improvements. I know this because I hear about their work at meetings, I read about it in letters from grateful patients, and I have seen it with my own eyes when I have visited the ED. I was thinking about why it is that the Emergency Department does so well, often against all odds. I have concluded...and I'm sure it will come as no surprise to the readers of this blog....that its about leadership.


Our Emergency Department has two great leaders: Paula Terzigni, RN, our Nurse Manager and Jeff Sternlicht, MD our Medical Director. Paula and Jeff meet with their Team at regular intervals; they celebrate and thank people for their hard work: they study the design for care in the ED and engage their staff in ways to make it better; they take on problems within their control and fix them; and they make direct requests of other leaders for help on things outside of their control. Paula and Jeff are "glass half-full" people. I am very grateful for their leadership and the hard-work and dedication of their staff.

The good news for me, our system, and the community we serve is that GBMC is full of great leaders like Paula and Jeff. I will be thanking them in this blog as we go forward.

The rest of us owe Paula, Jeff and their Team more than words of thanks, however. I would love to hear your thoughts on how to unburden the Emergency Department. What can we do to make non-Emergent care more available in other venues? How can we improve our ability to directly admit patients who need to be admitted from their doctors' offices? How can we move admitted patients from the ED to their inpatient beds faster? (see my blog of August 16, 2010). How can we "smooth" our inpatient bed demand over the five work days so it is more likely that we will have a bed for a sick patient in the ED? Please share your ideas!

Celebrating a Nursing Mentor

Jody Porter, MBA, RN our wonderful Chief Nursing Officer, and I visited our Surgical Intensive Care Unit last Monday in the morning at change of shift. As I walked into the staff room, I was really surprised to see so many younger nurses. I remember not too long ago when we were worried that we would not have enough nurses to serve the baby boomers because many of our nurses were themselves, baby-boomers, and would be retiring soon.

Our nurses work very hard, and this is certainly true in the SICU. The job in the SICU requires a high-degree of professional competency. Among the many advantages of youth are: energy, enthusiasm, and a lack of being set-in-your-ways. After a few words of introduction about myself, the staff gave me a brief education about what was going on in the unit. I then asked them the question: "Is there anyone who is really helping you in your work that I should be thanking?"

Without a moment of hesitancy, one of the nurses said: "Justine! She is always there for us." The nurse was referring to Justine Kellar, RN, BSN, the nurse manager of the SICU and Unit 38. In the photo above, Justine is seated fourth from the right. The other nurses chimed in with many reasons why Justine deserved to be recognized and it was clear that she was more than just a boss to them. Justine Kellar is a great example of a mentor. The dictionary defines a mentor as an adviser and supporter: somebody, usually older and more experienced, who advises and guides a younger, less experienced person. The downside of youth is that lack of experience. Our younger SICU nurses are smart, well-trained, and caring and they need a mentor.....and they've got one!

Nursing is a marvelous vocation. It is all about serving others. It is a difficult, physically taxing profession, but it is a joyful profession. It is people like Justine Kellar, who in guiding younger nurses in their work, help to keep the joy alive! I am so grateful to Justine and all of our other nurse leaders. When you see one of our nurses, please thank him or her for all that they do for our patients and our hospital.