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President's
Message
Alison J. McDonald, MD, FACEP- NJ ACEP President
New Jersey ACEP News - Vol. II, 2002
One year after September 11, we must all regroup and examine
where we are today and where we would like to be one year
from now. We have survived the nation’s greatest disaster
in years, and now need to look forward to our future and
that of our children. In this spirit, the Board of Directors
of New Jersey ACEP met in July and formulated a strategic
plan for the coming year.
Our strategic plan is aimed directly toward issues that
are important to the practicing emergency physician. First
and foremost, we must assure that each and every one of
us can obtain and maintain the appropriate environment to
do our work. The Board’s first goal is to establish
guidelines and set benchmarks for quality emergency care.
We are trying to establish a database that records the parameters
in which we function every day. We wish to examine ED volumes,
demographics, waiting times, waiting times for inpatient
beds and diversion hours. With this data we can present
a strong case for the barriers that we fact to practicing
excellent emergency medicine. For example, national ACEP
recommends that we no longer refer to the patients in our
departments waiting for beds as “ED holds.” Instead,
we should put the burden where it is and call them “Inpatient
Holds.” I have found that by using this strategy over
the past year and presenting to the administration the length
of time inpatient holds wait in the ED, that we have seen
a decrease in waiting time for inpatient holds. In addition,
our administration has opened a floor where inpatient holds
may go, therefore creating space in the ED for patient care.
Our second major objective is to assure universal access
to emergency care and high quality service. Professional
liability coverage that is appropriate and affordable leads
the list in this regard. This past June, over 4000 physicians
gathered on the steps of the Trenton Statehouse to protest
the rising cost of malpractice insurance. Physicians from
all specialties gathered to increase the awareness of the
legislature and the public to the lack of access to appropriate
care that is being caused by high liability insurance rates.
We went to ask for tort reform and caps on malpractice rewards.
Emergency physicians in NJ have personally seen the effects
of high liability insurance. Some of us have been unable
to obtain malpractice insurance at a reasonable rate due
to previous high claims. Others have been unable to reach
an obstetrical physician to help with a precipitous delivery
in the ED. Certain specialties have cut back on their on
call coverage for our departments leaving patients unable
to obtain emergency services for their injuries and requiring
transfers to outlying facilities. The Board of NJ-ACEP will
continue to work in the legislature for fair and equal compensation
for patient services. Last year, Russ Harris, MD, FACEP
was instrumental in obtaining additional Medicaid funding
for emergency services reimbursement making EM one of the
few specialties that experienced some additional compensation.
The current board is dedicated to continuing to lobby for
proper reimbursement as we know this will lead to improved
patient care and delivery of services.
We will continue our dedication to promoting education
in emergency care for all physicians, medical students,
residents, nurses, and allied professionals. Vic Almeida,
DO, FACEP, and the Education Committee presented a superb
education conference during our Scientific Assembly in April
and have numerous other courses scheduled for the upcoming
year. Our “On The Road” series, bringing educational
experiences to your back door, will continue as well. The
Board continues to be active in the area of EMS, having
physician leadership and representation on the MICU Advisory
Council, the EMS Council, and Medical Director for the EMS
Division in the DHSS. We also recognize that emergency physicians
need to assume leadership roles in out-of-hospital care,
including disaster management.
None of the above goals could be accomplished without adequate
representation of NJ-ACEP physicians at the table of medicine.
We are very fortunate that our Executive Director, Bev Lynch,
is also our lobbyist. Bev helps to assure that we have adequate
visibility in the legislative process and that the Board
is immediately aware of important bills and issues that
develop in Trenton. Our lobbyist keeps the appropriate legislative
representatives aware of our point of view and our needs
for delivering excellent emergency care in the state. In
addition, Russ Harris, one of our past presidents, is currently
serving as an advisor on health issues to one of the legislators.
This constant presence of emergency medicine in the State
legislature has and will continue to improve the environment
in which we practice every day.
To keep all of us abreast of all the developments in emergency
medicine, the Board is dedicated to promoting education
about emergency medicine to our membership, patients, and
the general public. We would like to create public affairs
messages on a seasonal basis to maximize public awareness
of health issues. We would like to increase public awareness
of issues facing Emergency Medicine, such as malpractice,
overcrowding, diversions, and decreasing availability of
on-call specialists. Joining our Board this year is Bruce
Bonanno, MD, who has a weekly television show where issues
affecting emergency medicine can be discussed. We are looking
forward to greater visibility with his help.
Last, but not least, we should all remember the reasons
that we entered emergency medicine originally. We were a
group that felt confined by the traditions of office medicine
and wanted to have fun practicing in an arena that provided
excitement and challenge. If we are not still having fun,
we all need to work to break down the barriers that are
restricting our practice. The current Board feels that Emergency
Physicians must become the leaders for the future direction
of medicine. We will be the ones to provide the answers
for the upcoming practices of medicine in our country. Emergency
physicians know and understand each specialty better than
any other physician. We need to become active in solving
the problems of each hospital in which we work. We all need
to be the leaders of breaking down the barriers to providing
an excellent patient experience. Do not be afraid to join
a hospital committee or an NJ-ACEP Board committee. You
will find that we all have the tools to create change and
move the House of Medicine to changes that will improve
our work environment and patient care. Let me know your
thoughts and ideas through membership@njacep.org.
Feel free to attend any NJACEP Board meeting or committee
meeting. Let us all work together to make emergency medicine
fun to practice.
Take Care,
Alison
^ Contents
Congratulations
New Jersey ACEP News - Vol. II, 2002
New Jersey’s Brennan Elected to ACEP Board of Directors
Congratulations to John A. Brennan, MD, FAAP, FACEP
- newly elected member of the ACEP Board of Directors. During
the ACEP Council Meeting in Seattle, Washington, Brennan
was selected from a field of six candidates to serve a three
year term - ably representing the Garden State. Brennan
is the first New Jersey member elected to fill this prestigious
position … we offer our heartiest congratulations to
Dr. John Brennan!
Congratulations to Victor Scali, DO, FACOEP, newly
elected president of the American College of Osteopathic
Emergency Physicians!
Dr. Scali is Co-Program Director of the combined internal
medicine/emergency medicine residency program at Kennedy
Memorial Hospital-University Medical Center, UMDNJ-SOM.
^ Contents
Editor's Note: 7th Scope of Work
Russell H. Harris, MD, FACEP
New Jersey ACEP News - Vol. II, 2002
November 1, 2002, begins a new program for Medicare Review:
The 7th Scope of Work, the next iteration of our ongoing
Medicare review. Over the past 3 years we in NJ have been
involved in the evaluation of the 6th Scope of Work and,
though the Emergency Departments have generally done well,
New Jersey has generally done poorly overall. The NJ Peer
Review Organization (PRO) has committed to improving our
performance as we enter the 7th Scope of Work and hopes
to take us from our current status at 48th in the country
to the top 10 status.
From an Emergency Medicine perspective, we have less responsibility
in this cycle as the criterion for Stroke are no longer
included in the ongoing evaluation. Replacing Stroke is
a new indicator for Surgical Wound Infection Prevention
(SIP). We will continue with the following Criterion, however,
which have significant impact on Emergency Medicine:
Acute MI
- Aspirin use at or before arrival
- Beta Blocker use at arrival
- Median Time to Thrombolysis: 30 minutes or less
- Median Time to PTCA: less than 90 minutes
CHF- no specific ED Indicator
Pneumonia
- Antibiotics within 4 hours of arrival (Note shortened
time interval from 8 hours)
- Compliance with Antibiotic guidelines
- Blood cultures with 24 hours of arrival and prior to
the initiation of antibiotics
- Pneumonia Vaccination (age 65 and older)
- Influenza Vaccination (age 55 and older)
- Documentation of Oxygenation within 24 hours by Pulse
Ox or ABG
Surgical Infection Prophylaxis
Prophylactic antibiotics within 1 hour prior to surgical
incision
Your hospital Performance Improvement Departments will
be monitoring these criterion closely as we seek to improve
the quality of care provided in New Jersey. If you have
any specific questions related to this issue, feel free
to contact your PI Department or The Peer Review Organization
of New Jersey, Inc. The point of contact is Joyce Pontbriand,
RN, MED, CPHQ, at 732-238-5570, ext 2053 or NJ1 pro.jpontbriand@sdps.org.
^ Contents
Thanks
New Jersey ACEP News - Vol. II, 2002
The New Jersey Chapter of ACEP’s Annual Reception
held during the ACEP Scientific Assembly was generously
sponsored by:
- Aircast, Inc.
- EmCare, Inc.
- Emergency Medical Associates
- Emergency Physician
- Associates/Team Health
- Physicians’ Practice
- Enhancement, LLC
^ Contents
Strategic Plan of the American
College of Emergency Physicians, New Jersey Chapter, Adopted
September 13, 2002
New Jersey ACEP News - Vol. II, 2002
Section 1 - Mission
The New Jersey (NJ) Chapter of the American College of
Emergency Physicians (ACEP) exists to support quality emergency
medical care and to promote the interests of emergency physicians
and our patients.
Section 2 - Purposes and Objectives
- To establish guidelines and set benchmarks for quality
emergency medical care.
- To encourage and facilitate the postgraduate training
and continuing medical education of emergency physicians.
- To encourage and facilitate training and education in
emergency medicine for all medical students.
- To promote education in emergency care for all physicians.
- To promote education about emergency medicine for our
patients and for the general public.
- To promote the development and coordination of quality
emergency medical services and systems.
- To encourage emergency physicians to assume leadership
roles in out-of-hospital care and disaster management.
- To evaluate the social and economic aspects of emergency
medical care.
- To promote the universally available and cost effective
emergency medical care.
- To promote policy that preserves the integrity and independence
of the practice of emergency medicine.
- To encourage and support basic and clinical research
in emergency medicine.
- To encourage emergency physician representation within
medical organizations and academic institutions.
Section 3 - Objectives with Strategies
and Tactics
1. To establish guidelines and set benchmarks for quality
emergency medical care.
Strategy: Develop measurement tools that can help directors
measure their EDs performance and resources for their particular
volume and demographics. Develop strategies that will assure
the viability and growth of Emergency Departments.
Tactics:
- Create a database for tracking the following parameters:
a. ED volume
b. Demographics of ED volume
c. LWOBS/AMA
d. Average waiting time for physician
e. Average waiting time for inpatient bed
f. Turn around time for admissions and discharge
g. Define inpatient holds and impact on ED patient care
h. Hours / week on diversion
- Develop a program for ED directors to measure and record
the above parameters
- Enter data into a statewide database
- Distribute information to appropriate authorities to
improve ED patient care
Implementation: Practice
Management Committee
2. To encourage and facilitate the postgraduate training
and continuing medical education of emergency physicians,
nurses and medical students
Strategy: Assure that
all emergency physicians in New Jersey and the Mid-Atlantic
region recognize NJ Chapter as a provider of superior CME
programs.
Tactics:
- Provide CME instruction in EM at least once a quarter
a. Residents' Conference
b. Annual Meeting based upon 2002 format
c. Present APLS courses in Atlantic City
d. One-day courses
e. On the Road presentations
f. Offshore course development
- Partner with other successful EM courses to broaden
scope of presentation
- Invite nurses and allied health professionals to actively
participate in NJACEP education conferences
- Encourage medical student participation, including no
conference fees for students
- Encourage all Universities in NJ to form Emergency Medicine
Clubs for students, and encourage NJ-ACEP members to participate
- Encourage propagation of research in EM residencies
and community physicians
- Encourage the addition of minorities and women to the
field of emergency medicine
Implementation: Education
Committee
3. To promote education about emergency medicine for
our membership and our patients and for the general public
Strategy: Create public
information materials about NJ-ACEP activities and emergency
medicine contributions and provide them to newspapers and
the media and hospitals for widespread dissemination.
Tactics:
- Create public affairs messages on a seasonal basis
to maximize publication potential
a. Spring - Sports injuries
b. Fall - Back-to-school safety
c. Summer - Water sports prevention tips
d. Winter - Safe holiday tips
- Make the public aware of issues facing Emergency Medicine
a. Malpractice crisis
b. Overcrowding
c. Diversions
d. Lack of on-call specialists
e. Threatened EMS structure
- Distribute all activities to NJACEP membership
a. Quick Scan
b. E-mail and updated website
c. Newsletter
Implementation: Public
Relations Committee
4. To promote the development and coordination of quality
emergency medical services and systems.
Strategies: Assure the
viability and growth of EMS in NJ by having emergency physicians
providing leadership and input at all levels of the system
in the State.
Tactics:
- An emergency physician will lead the MICU Advisory Council
- An emergency physician will be on the EMS Council
- An emergency physician will be the Medical Director
for the EMS Division in the Department of Health and Senior
Services
- Meet with the Commissioner of Health and Senior Services
to lobby for the creation of a Blue Ribbon Panel or Task
Force to address the EMS issues in the State
Implementation: Emergency
Medical Services Committee
5. To encourage emergency physicians to assume leadership
roles in out-of-hospital care, including disaster management
Strategies: Assure that
emergency physicians are appointed to the highest positions
in the State that oversee prehospital and emergency care
in the State.
Tactics:
- An emergency physician will be the EMS consultant to
the DHSS
- An emergency physician and a pediatric emergency physician
from NJ ACEP will be appointed to the EMSC Advisory Council
- Emergency physicians will be appointed to any Task Forces
or Committees that address preparation for Nuclear - Biological
- Chemical attacks
Implementation: EMS
Committee (Lead); Government Affairs Committee
6. To promote the universal access to emergency care
Strategy: Assure that
every patient in New Jersey has equal access to emergency
care and proper reimbursement for care is available. Provide
high quality care and service in every Emergency Department
in the State
Tactics:
- Continue to work in the Legislature for fair and equal
compensation for patient services
- Continue to address Medicaid and Medicare compensation
- Continue to address the proper focus of EMTALA in providing
equal care for all patients
- Encourage the development of universal health coverage
for all patients to ensure the best care for all
- Work within the Legislature to assure that every emergency
physician has professional liability coverage at a cost
affordable to all physicians
Implementation: Government
Affairs Committee (Lead); Coding and Reimbursement Committee;
Practice Management Committee
7. To encourage emergency physician representation within
medical organizations and academic institutions
Strategy: Assure that
Emergency Medicine has a voice at the table of Medicine.
Tactics:
- Assure visibility of EM in the legislative process
a. Support a lobbyist to represent NJ-ACEP interests
b. EM physician as advisor to the legislature
c. Board and NJ-ACEP membership support of STATPAC
- Assure representation of Emergency Medicine at all State
meetings of NJ physicians
- Assign EP to attend all MSNJ meetings
- Support EP in roles in state government
Implementation: Government
Affairs Committee (Lead); Executive Committee
^ Contents
Newsletter continued
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