"It's a strategic failure for hospital and emergency medicine programs to focus entirely on separate functions rather than their collective impact on the patient."
That statement is from a 2018 SCP Health article regarding the benefits of EM and HM collaboration. Over three years later, it still holds true.
With the knowledge and experience gained from the COVID-19 pandemic, it's time to take another look at EM and HM integration to make both departments stronger, together, for the benefit of providers, hospitals, and the patients they serve.
EM and HM Providers—Friend or Foe
Friction between EM and HM providers can negatively impact the entire hospital. Poor communication, care redundancies, and clinical variation caused by disparate, uncoordinated departments compromise cost efficiency, patient experience and safety, physician satisfaction, and care consistency.
On the other hand, efficiency and care quality improve dramatically when EM and HM providers are fully aligned. It doesn’t have to be one at the expense of the other, synergy exists when each department works to strengthen the other.
Interdependent services enable the right teams to do the right things at the right time.
Integrated EM-HM Department Benefits
Integrated EM and HM departments offer providers, hospitals, and patients a wealth of benefits that positively influence ROI, physician retention, and patient care.
1. Integrated Systems are Resilient Systems
An integrated EM and HM system is more than just the sum of its parts. System integration allows for adaptive, dynamic behavior that increases resilience and medical leadership and gives each department the ability to flex and change in response to new situations.
The COVID-19 pandemic is a case in point. The need to adjust to constantly updated treatment recommendations, limited knowledge about how to treat patients, and issues concerning lack of PPE and beds tested the clinical resistance of both EM and HM providers and their staff.
Success in treatment required building an interdepartmental resilience "culture" consisting of ongoing communication and mutual support.
2. Integrated Systems Improve and Standardize Care
Departments that work together to create new patient care standards and protocols come with their own set of benefits, including:
- Improved patient flow, speeding care and creating efficiencies—especially important in surge situations as well as every day;
- Safer care transitions from one department to another;
- Reduced redundancies from improved communication and collaboration;
- Fewer questions regarding what to do about complex patients;
- Guideline creation to address specific areas of concern.
3. Integrated Systems Rely on Joint Standards and Communication
Setting handoff standards and instituting KPIs for both sides to follow fosters mutual trust and joint responsibility, focusing both departments on achieving the best patient care.
An EM-HM Joint Operations Committee (JOC) is the proper avenue to ensure everyone is on the same page to review the standards, keep communication lines open and the big picture in mind, creating an environment that allows for reactive changes in times of need.
To cite one example of JOCs efficacy, the JOC at an SCP-managed hospital reviewed EM-HM issues and obstacles, then proposed solutions resulting in improved compliance rates (from 50 to 90 percent) in the first year and a 24 percent decrease (37 to 13 percent) in sepsis mortality during the same period.
4. Integrated Systems Produce Happy Providers
Collaboration and shared goals create a positive atmosphere for providers to work, while proper hospital performance management leads to happy providers, decreasing turnover rates, and increasing physician satisfaction.
It follows that happy providers equal happier patients, which leads to better patient experience and further incentivizes hospitals to boost care quality. It becomes a repetitive virtuous cycle, the natural consequence of healthy EM and HM alignment.
Other benefits that accrue from EM-HM integration include:
- Increased throughput;
- Decreased emergency department ALOS (through reduced boarding times, decreased bottlenecks, and improved inpatient bed utilization);
- Reduced inpatient readmission rates;
- Better communication with care management for discharge planning;
- Stronger physician-to-physician clinical coordination and care planning (through shared communication channels);
- Optimized efficiencies and cost control (through reduced unnecessary or repeat diagnostics).
How to Improve EM and HM Integration
There is no question that better interdepartmental communication, collaboration, and integration offer many benefits. The question is, how to bring those about? The simple answer: Get both teams together, reading from the same page. That may not be as simple as it sounds, however. Disparate vantage points and competing priorities can often get in the way of a collegial partnership and singular focus on patient care.
Open lines of communication, agreed-upon EM-HM process standards, mutual goals, clear accountability, and objective data measures are the keys to achieving an evolved, integrated approach.
We have already alluded to the fact that the best way to bring EM and HM into healthy alignment is by forming a Joint Operations Committee. To that end, SCP Health offers a free guide to establishing an EM-HM JOC that includes critical steps to formalize shared goals and achieve performance improvement.
Informal Social Gatherings
Coming together in structured, organizationally initiated settings, such as the JOC, is one way to promote accountability and collaboration among EM and HM team members. Another is to encourage members of both departments to spend time together socially. Arranging a lunch, group outing, or other social function gives hospitalists and ED physicians a casual venue to form personal bonds and build trust.
Comradery and trust also breed situational awareness, which goes a long way toward diffusing preconceived notions and illuminate the ways EM and HM services impact each other. When situational awareness increases, providers from both services are cognizant of the other's challenges and how they might lessen the burden on one another. For example, simply being aware that the ED program is struggling with staffing issues and volume surges gives the HM physician added context and may increase their willingness to offer a mutually beneficial compromise.
When EM and HM programs place their focus on separate functions rather than working collaboratively to advance patient health, your hospital and patients pay the price. Strengthen your entire hospital by aligning and integrating your EM and HM programs.
At SCP, we know how to make that happen, using our EM-HM "One Team" methodology. It is a comprehensive approach to EM and HM performance management that ensures hospital leadership and clinical staff unite around common goals and choose cohesive growth strategies, resulting in significant quantitative metric transformation for both specialties.