GEttING DOWN tO
BUSINESS
In 2014 we have focused our efforts
on the Fast Track, known as ED 2. We know
there have been problems with throughput
in the SBH ED. The time it takes a patient
to get in and out of our emergency depart-
ment has been simply too long. If Fast
Track efficiency is continuously improved,
it relieves pressure elsewhere and increases
patient satisfaction. An efficient Fast Track
is the engine that empties the waiting room
and makes us better in all areas of the
department.
Data told us that the average time pa-
tients spent in our Fast Track was between
six and seven hours. The emergency medi-
cine industry expectation is less than three
hours! Such a prolonged length of stay can
lead to important clinical delays, crowding,
compromised patient safety and poor
patient satisfaction.
In a short time we’ve been able to
reduce ED 2 throughput to between four
and five hours. We’ve been successful in in-
creasing the efficiency of the patient-physi-
cian encounter and we’ve decreased the
time it takes for a patient to be discharged
after that important decision is made. As
our throughput times have improved, so
too, it seems, have our patient satisfaction
ratings. But we are just getting started.
pLANNING OUR NExt StEpS
We must understand the patients who
come to our emergency department. We
must know our community and work effec-
tively to address their needs. An emergency
department is a very complex place, with
many sub-sections, processes and relation-
ships between patients and staff.
Indeed, an ED is more than a clinical
unit. It is also the portal to the hospital and
a place for answers, reassurance, social in-
teraction and refuge 24 hours a day. Illness,
injury and despair do not care what time it is
and do not care if it’s a weekend or holiday.
While working to maintain and im-
prove upon our gains in ED 2 our next
steps, working closely with our new ED
Nursing Director Kim Filauro and her excel-
lent nursing staff, will be to re-organize our
Ambulance Triage and ED 3 areas.
Ambulance Triage is where most
very sick patients arrive. The transfer of in-
formation, the recognition of acuity and the
early initiation of treatment at Ambulance
Triage need to be reliable and effective.
Those EMS professionals who bring pa-
tients to our ED appreciate a quick and ef-
fective reception. A properly equipped and
staffed area in the ED dedicated to Ambu-
lance Triage is an important next process
improvement at SBH.
This means we need more room, we
need to work more efficiently on throughput
in ED1, and we need ready access to ED 3,
our Observation Unit, 24 hours a day.
Collaborating closely with all clinical
departments at SBH, we intend to use ED 3
as a place where prudent admission and ob-
servation decisions can be made by proto-
col, creating much-needed capacity else-
where in the ED. The parts need to function
seamlessly.
tHE GOAL
When it all comes together, the re-
sults will be magnificent. I’ve seen it hap-
pen. The goals are to establish reliable and
standardized diagnostics and therapy, effi-
cient and timely care that is satisfying to our
patients, capacity that is in equilibriumwith
demand, and a caring, attentive and recep-
tive touch by a staff full of compassionate
listeners.
Our outstanding emergency medi-
cine residency program will continue to be
a place where residents learn, faculty teach
and academic and operational break-
throughs evolve that are directly applicable
to the unique community we serve. The
very best techniques, practices and technol-
ogy will be applied.
The goal is to make SBH’s ED better
than any other ED in the Bronx. It’s begin-
ning to come together. It won’t happen
overnight, but it’s an exciting time and I be-
lieve we’re well on our way.
Finally, I would like to thank everyone
for welcoming me so warmly to the SBH
family. When I first came here I was very
impressed with the leadership and the mis-
sion. I was just as impressed with the
warmth and energy of the people that work
here. That respect has only increased.
Emergency Medicine at SBH
planning Our Next Steps
4
| SBH-PHYSICIAN
SBH-PHYSICIAN |
5
DANIEL G.
MURpHY,
MD, MBA
CHAIRMAN,
EMERGENCY
MEDICINE
“We must understand
the patients who come
to our emergency
department. We must
know our community
and work effectively
to address their needs.
An emergency department
is a very complex place,
with many sub-sections,
processes and relationships
between patients
and staff.”
Medical students and residents benefit fromoutstanding clinical training in the SBH emergency
department.
Kim Filauro, RN, BSN, MSN, ANP, director of
nursing for the emergency department.
MD
Chicago Medical School,
North Chicago, IL
Internship/Residency
Emergency Medicine
Cook County Hospital,
Chicago, IL
MBA
Hofstra University,
Hempstead, NY
Emergency Medicine was recognized as a
specialty in 1979 and I was lucky enough to
witness its early years.
I was a medical student rotating at
Cook County Hospital in Chicago during
the 1980’s and I was quickly hooked. The
pace, the clinical breadth, the personal in-
teractions, and the need to think on your
feet as you use your hands – it was every-
thing I wanted as a physician.
I was then accepted into the second
class of the Cook County Emergency Med-
icine Residency Program and when I grad-
uated I worked there as an attending on
their faculty.
Over a decade, I witnessed the trans-
formation of the Cook County ER from a
crowded and disjointed collection of parts
into one of the most respected academic
emergency departments in the United
States. The progress we made resulted from
years of hard work, good leadership, and a
purpose and vision that were consistently
and clearly communicated. It was not easy.
Money was tight. There were many strug-
gles and disappointments for every success,
but the successes did come.
My career after Cook County took
me to several emergency departments, ac-
ademic and non-academic, large and small,
urban and suburban. I am very familiar with
the current best practices of emergency
medicine and have implemented most of
them in a variety of settings.
This brings me to my role today as
chairman of the department of emergency
medicine at SBH, a clinical environment
that feels familiar, indeed just like home.
Some of the same techniques and certainly
the same diligence and effort will be applied
here – and I have faith that the successes
will be remarkable.
Photo Dan Z. Johnson Photography
