Improving the ED Experience: Focus on Teamwork

Added on Jul 2, 2015

"Emergency medicine is a team sport, so you have to be a team player,” according to Dr. Azita Hamedani, chair of the Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health. This means adopting a team mentality to drive every action and decision, she explained in a Partners magazine interview about the challenges of running an academic emergency department in today’s changing health care culture.

“The nature of the ED is such that you’re always in the position of asking for things from other people. Every day, being able to do your job requires asking for and getting things from other people, whether it’s a consult or an admission or just an extra pair of hands. So whenever you’re trying to make an operational change, you can’t have a personal agenda. You have to keep focused on the best interest of the patient,” Dr. Hamedani. When it comes time for some of the more difficult changes, “if you haven’t deviated from that patient-centered mission, people will be more open to them.”

A focus on the team nature of ED care is especially useful as organizations prepare for the anticipated Emergency Department Consumer Assessment of Healthcare Providers and Systems (ED CAHPS) survey. 

In the shift to value-based care, emergency departments—as with every area of medicine—must be able to demonstrate value. This requires measuring and communicating (internally and externally) the quality of the care they deliver and engaging providers and staff in efforts to drive improvement. 

Performance on measures of teamwork—collaboration, communication and care coordination, in particular—influences patients’ overall perception of not only their ED care experience, but also their subsequent inpatient experience if they are admitted through the ED. It may also influence quality, safety and profitability.

To this end, hospital leaders should be looking at outcomes to assess how well ED physicians are collaborating and communicating with specialists with an eye toward managing patients efficiently, ordering the tests and procedures the specialists will want and need, and sharing decision making so that care is continuous and coordinated and handoffs are seamless. 

The elements of surprise and uncertainty that define emergency medicine make one additional consideration necessary: the degree to which ED physicians able to address all of the above in an environment in which change is the only constant. 

“You have no idea what’s coming—whether it’s a heart attack, a fish hook in an eyeball, or even a police shooting,” Dr. Hamedani explained. “You have to be ready and you have to constantly assess your resources and make split-second decisions.” 

In addition to the variety of patients and conditions, “there is constant change in the department’s operations. As other clinical services change the care they give, it often impacts what is expected of the ED for the first couple of hours of the patient’s care. We constantly modify, revise and update our policies and procedures so that we can continue to provide the best care we can in partnership with the other clinical services.” In that way, she said, EDs must always be looking for ways to