The Pulse July 2005

The PULSE

Osteopathic Emergency Medicine Quarterly VOLUME XXX NO. 2

JULY 2005

ACOEP's 30th Anniversary Editorial

Drew Koch, D.O., FACOEP, Editor Imagine spending five days on an Indian reservation in the Sonora desert in Phoenix, Arizona where ACOEP held its 2005 Spring Seminar and membership meeting. One would conjecture an image of destitution and despair.

The Wild Horse Pass Resort located on The Gila River Indian Reservation, where ACOEP’s Spring Conference was held, dispelled any melancholic images of an Indian Reservation. The Pima and Maricopa Indian tribes jointly occupy the 372,000-acre Gila River Community and opened the Sheraton Wild Horse Pass Resort in 2002.

The 500-room resort is a testament to the tribes past and future. The tribe’s history is depicted by murals in the hotel lobby and is modeled after a traditional native roundhouse. Like traditional Indian homes the entrance to the hotel faces east. As the resort’s name implies, there is a herd of 1500 wild horses that roam the reservation.

The viability of the Pima and Maricopa tribes rests in endeavors like the Sheraton Wild Horse Pass Resort. This resort not only is family friendly, but offers three outdoor swimming pools, a luxurious spa, two 18-hole golf courses, an equestrian center, on site gambling and is capable of hosting ACOEP’s conference.

The mundane origin of ACOEP began in the kitchen of Dr. Bruce Horton’s home in Toledo, Ohio. The notoriety of Toledo, prior to this meeting, was the home of Corporal Max Klinger of the television show M*A*S*H and of the Toledo Mud Hens, a minor league baseball team. The founding fathers that met on October 5, 1975 were Drs. Bruce Horton, Richard Ballinger, Donald Cucchi, Anthony Gerbasi, Robert J. George, Robert L. Hambrick, Scott Swope, James Budzak and James Grate. They created the basis for the American College of Osteopathic Emergency Medicine. They formulated a letter of intent to form a specialty college of emergency medicine and forwarded this letter to the AOA to seek affiliation within the AOA.

At the 1975 AOA Convention this fledgling specialty met and elected its first officers. Those elected were: Bruce Horton, DO-President; Anthony Gerbasi, DO-Vice President; Richard Ballinger, DO-Secretary; and Robert Hambrick, DO-Treasurer. It was not until July 1978 that the AOA recognized and chartered the American College of Osteopathic Emergency Physicians.

The original 16 charter members were: Robert Aranosian, DO; Fred Bailor, Jr., DO; John Becher, Jr., DO; Robert Breckenfeld, DO; David Brown, DO; James Budzak, DO; Robert Erwin, Jr., DO; Joseph Imbesi, DO; Patrick Karson, DO; Anthony Mosca, DO; Thomas Mucci, DO; Steven Parrillo, DO; Larry Stalsonburg, DO; and

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Louis Steininger, DO. Current membership in ACOEP is approximately 2,100 with 1,600 active members and 500 resident and intern members. There are currently 3500 osteopathic physicians practicing Emergency Medicine of which, 2/3 of these Emergency Physicians belong to ACOEP.

In 1979 there were four AOA approved Emergency Medicine Residency Programs which were: Chicago College of Osteopathic Medicine; Detroit Osteopathic Hospital; Grand Rapids Osteopathic Hospital; and Philadelphia College of Osteopathic Medicine. Now, there are 37 Emergency Medicine Residency Programs. In 1984 the first fellowship ceremony included the following 10 members: Robert Aranosian, DO; Richard Ballinger, DO; John Becher, Jr., DO; James Budzak, DO; Donald Cucchi, DO; Anthony Gerbasi, DO; James Grate, DO; Robert Hambrick, DO; Bruce Horton, DO; and Edward Samara, DO. This year’s fellowship ceremony will have 35 new Fellows.

As the membership of the College grew, the needs of the members expanded as well. The College moved from Ohio to Chicago and has a full-time Executive Director and support staff. The College has a Student Chapter and Resident’s Chapter. There are Active Members, Charter Members, Honorary Members, Life Members and Resident and Student Members. To accommodate the growing need of CME among the members, ACOEP not Continued on page 4

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Presidential Viewpoints

of the member. We conducted round table discussions on six key topic areas. Through a nominal group method, the Board Paula Willoughby DeJesus, D.O., FACOEP developed six important questions to pose to the membership for direction. At the It is a com- nizations in multiple areas by its Board and membership meeting, we broke into six mon practice for put organizations in one of five spectrums groups with members migrating to the one o r g a n i z a t i o n s of functioning. In order of sophistication, of the six round table discussions of their and businesses to the categories are Immature, Fragmented, choice. Board members were facilitators at undergo a stra- Cohesive, Effective, and Synergistic. It found each round table discussion group. Their job tegic planning ACOEP to be a highly cohesive organiza- was not to steer the group but to allow an process. Usually it is tion. The survey revealed we have strong orderly process for an open discussion and conducted in- relationships within the organization, good act as a recorder of the results. The results ternally by top contact with the professional world around of these discussions would then be funneled leadership, of- us, are organized, focused and do recognize to the appropriate ACOEP Committee for ten in conjunc- each other’s successes and say thanks. Areas action discussion and folded into the ACOEP tion with a pro- identified as needing work were establishing Strategic Plan. Members then became the fessional facilitator to guide the leaders planning processes, increase self -leadership, instruments of strategic planning. Within this process. Some organizations or become member focused, have more defined out further ado, here are the round table businesses may follow through with the relationships and develop mechanisms to questions and the discussion summaries. well-held premise to revisit their strategic measure our progress. plan on a regular basis. Some groups have Through multiple sessions with our What membership issues should ACOEP taken it to “the next level” and the strategic facilitator, we began to retool the ACOEP pursue? plan has become a living document in their Strategic Plan and ACOEP! We want to see ➢ Website daily business. The plan not only becomes ACOEP move into the Effective category • CME by website to include short course topics (1-2 hours/credits) the road map but the systematic directions and certainly have Synergistic in its future and measure of the daily success of the target. We realized to truly make ACOEP • Online course registration/payment organization. a member driven organization we needed • Online payment of dues Our Executive Director, Jan Wachtler, to put strategic planning in the hands of • Online requests for CME topics developed the first ACOEP Strategic Plan in the member. We needed to get strategic • Online availability of all publications from ACOEP 1994. This represented ACOEP’s first step planning out of the traditional boardroom at thinking about itself on a global scale from setting. This would be “the next level” • Website archiving of all publications a conceptual perspective. The Plan has been for our organization to make this a living, • Website bundling of COLA topics for download revised twice since then in 1998 and 2000. working plan and not just a document we Immediate Past President, Victor Scali, put re-visit from time to time. The plan would • Links to agencies strategic planning in the hands of ACOEP come from the top down like all other busi- ➢ Discount for attending more than 2 ACOEP sponsored CME events in leadership. Because of his foresight and ini- nesses or organizations. The top, however, one calendar year with the 3 events tiative, a retreat was planned for the entire is not ACOEP leadership, but ACOEP discounted 50%.

Board of Directors this past February. The membership. session was conducted with a professional Every ACOEP Committee is currently ➢ Providing break in dues costs for those members who are also members of facilitator and was framed on our current working on their own goals and objectives.

ACEP or AAEM and who pay dues to Strategic Plan and a preliminary survey of The Board can then lead ACOEP with one or both of these organizations. the Board’s perspective of the organization. these directives as the basis for its decisions.

The facilitator analyzed the survey prior to At the Spring Seminar, we took another Continued on page 25 the retreat. It was designed to evaluate orga- tactic to put strategic planning in the hands

Table of Contents Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Presidential Viewpoints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Executive Director’s Desk . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical Staff Bylaws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Membership Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Guest Contributor, Joseph Dougherty, D.O., FACOEP . . . . . .

1 3 5 6 7 9

Guest Contributor, Wayne Jones, D.O., FACOEP . . . . . . . . . 11 Resident Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Positions Available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23, 24 Continuing Medical Education Calendar . . . . . . . . . . . . . . . . 25 ACOEP Welcomes New Fellows . . . . . . . . . . . . . . . . . . . . . . . 26 Ethics in Emergency Medicine . . . . . . . . . . . . . . . . . . . . . . . . 26

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THE PULSE–AN OSTEOPATHIC EMERGENCY MEDICINE QUARTERLY 142 E. Ontario St., Suite 1250 Chicago, IL 60611 312-587-3709/800-521-3709 Editorial Staff Drew A. Koch, D.O., FACOEP, Editor Paula Willoughby DeJesus, D.O., FACOEP Peter A. Bell, D.O., FACOEP Bobby Johnson, Jr., D.O. Janice A. Wachtler, Executive Director Publications Committee Drew A. Koch, D.O., FACOEP, Editor & Chair Peter A. Bell, D.O., FACOEP, Advisor Bobby Johnson, Jr., D.O., Vice Chair/Asst. Editor James Bonner, D.O., FACOEP Annette Brunetti, D.O., FACOEP Randall A. Howell, D.O., FACOEP William Kokx, D.O., FACOEP

ACOEP celebrates its 30th birthday this year. It began inconspicuously as a new, small specialty college of the AOA only offers CME at the Scientific Seminar in 1975 and has grown to be the second at the Annual AOA Convention and the largest specialty in the AOA hierarchy. The Annual ACOEP Spring Conference, but history of the Maricopa and Pima Indians is offers the following continuing medical entrenched in the architecture of the Wild education: Oral Board Review; Emergency Horse Pass Resort. This lucrative resort and Medicine: An Intense Review; Program casino provides both financial security for Directors Workshop; and COLA Essentials. the future and a glimpse of their ancestry.

Like the Maricopa and Pima Previous CME offerings were: Toxicology; Indians, ACOEP has a rich, if not colorful, An Intense Review and an Overview of history.

However, its future is not incumEmergency Medical Services. bent on large land assets, but rather on its

ACOEP has a quarterly publication, members past, present and future. In The Pulse, which is available in print or on order for ACOEP to survive and thrive the the College’s website. Some membership next 30 years, it must continue to serve benefits are travel discounts, discounted its members.

CME for members, car rental discounts, hotel discounts and insurance and estate planning.

Editorial, Continued from page 1

The PULSE is published quarterly (January, April, July, and October) and distributed at no cost by the ACOEP to Members and libraries of Colleges of Osteopathic Medicine by the National Office of ACOEP. The Pulse and ACOEP accept no responsibility for statements made by contributors or advertisers.

Display and classified advertising are accepted. Display advertisements should be submitted as camera-ready, pdf, or jpg formats in black and /white art only.

Classified advertising must be submitted as typed copy, specifying the size, and number of issues in which the copy should be displayed. The name, address, telephone numbers and E-mail address of the submitting party must accompany advertising copy. Advertisers will be billed for ads following the publication of their advertisements and payments will be due within 30 days of the issuance of the invoice.

The deadline for submission of advertising is the first of the month preceding publication, i.e., December 1, March 1, June 1, and September 1. The deadline for article submission is November 15, February 15, May 15, and August 15. ACOEP and the Editor reserve the right to decline advertising and articles for any issue.

The PULSE and ACOEP do not assume any responsibility for consequences or response to an advertisement. All articles and artwork remain the property of the Pulse and will not be returned.

Subscriptions to the Pulse are available to nonACOEP members or other organizations at a rate of $50 per year.

The ACOEP has recognized

Sheldon R. Bender and Arnold J. Bender, CPA of GCG Financial as Investment Specialists for Life, Disability, and other financial needs.

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Executive Director’s Desk Janice Wachtler

A Patient's View of Patient Advocacy Recently I spent several days in the hospital following surgery and got an up-close-andpersonal view of managed care, and it was scary. The last time I spent any time in a hospital was in 1977 when I was being treated on a medical floor for a viral infection that contracted after being bitten by a Kindergarten student.

In 1977, the hospital was staffed with nurses, orderlies, nurse’s aides and physicians. This year it was a different story.

There were only three nurses on duty and five certified nursing assistants that staffed the surgical ward of this Catholic teaching hospital in Chicago. I only saw one resident physician during my stay, who introduced herself quickly and never had a nametag on so that in my pharmaceutical induced haze, I could at least remember her name.

At each shift change, a C N A would come into my room and write his or her name and the nurse’s name on a board and then introduce themselves to me while taking my vital signs. I only saw the nurse when medications were distributed.

I have often thought it was not important for family and friends to spend countless hours at a patient’s side to visit the patient and sometimes act as an intermediary for the patient. So, being of this mind, I discouraged family and friends from parking at my bedside, believing it was more important for me to rest and regain my strength. What I learned is that in today’s hospital atmosphere, it is very important for the patient to have this support. Likewise, it was absolutely necessary for the patient and doctor to work together to get things done at the hospital level.

When I came out of surgery, I was concerned when both my surgeons called me to tell me what they had ordered for me

as far as medicines and emphatically stated that I should call the nurse if I needed anything. They both told me they would see me the next day and I should make sure that I use the morphine for pain. After speaking with them, the nurse came in to tell me that she had spoken to my doctors and I should call them if any beepers went off and that the C N A would be there for anything else. I did not remember anything else for many hours after surgery until the shift change at 11 p.m. when the C N A came in to take my vitals.

I saw my surgeons every day and every day, each would tell me what they were ordering – I thought it was odd but now know that they were telling me so that I could follow through with the nursing care staff. A few days into my stay, I asked why I was still getting copious amounts of fluid and was now retaining fluid, when my surgeons had informed me the day before that I would have the IV and catheter removed. They looked at me quizzically and said, that they would be removed when the doctors ordered. Never once did they refer to the chart, no one other than my doctors ever appeared in my room with my chart. Finally, swollen and in pain I insisted that these be removed and demanded that they call my physician. It was only at that time that this was removed. When my physician came in later that day, she showed me that both physicians had ordered it to be removed 12 hours before it was. I thought what is going on here!!

What I have come to believe, and this is my opinion only, is that managed care, the nursing shortage and the insurance companies, have devastated the hospital health-care system. The patient care is minimal in many settings and nurses are spread too thin to adequately supervise patients in any setting, acute or non-acute. Certified Nurses Assistants are trained to supplement the patient care that do not require a lot of medical knowledge, but to assist the patient in his or her personal needs.

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What I have also come to believe is that patients need to be advised by their physician what is going to happen to them, keep them informed of what is being ordered for their care and to advocate for them.

Patients need to have family and friends there with them to be their voice to see that they are receiving the care necessary.

When patients are told by nursing staff that they must walk, it is up to the patient to ensure that someone is there to assist them until they can do things by themselves, if your family is not there. You will be a pain but you will get care.

The American health care system needs help before it sinks permanently into an abyss of regulations. Nursing needs to be upgraded and the people who have taken on the burden of nursing the sick need to have the respect and recognition that they deserve, and together with physicians and patients they need to work as a team to assist in patient care until such time as the system is changed or replaced.

I realize that as emergency medicine physicians, you can only aid and advocate for your patient in the emergency department; but it is important for you to continue to advocate for your patients as they are admitted, because once your patient disappears in the morass that is our current healthcare system, they will not get the quality of care they received in the ED.

Medical Staff Bylaws: Do the Rules Speak to Continuous Hours On-Call?

Long hours on duty for medical and surgical residents has been highlighted as a significant patient safety issue. In October 2001, the American Association of Medical Colleges (AAMC) issued policy guidance1 on the subject, suggesting that residents work no more than 24 hours consecutively in most clinical rotations due to concern about fatigue and subsequent patient safety issues. For intense clinical rotations, such as the emergency department and critical care units, the AAMC suggested no more than 12 consecutive hours. Although some leeway was built in for continuity of care, the guidelines have become the standard in AAMC residency training programs.

What is striking, however, is that no such regulation exists for credentialed physicians at most health care organizations. If the AAMC is correct about the fatigue factor for residents who work long hours, the same should hold true for busy clinicians.

A Common Practice

Many medical staff bylaws include a provision for on-call rotation. Through medical departments or units, members of the medical staff “take call” overnight or on weekends. Although the on-call duty hours may not be taxing for some specialty groups, the same is not true for others such as obstetricians and surgeons. Many of these physicians have busy daytime practices. It is not uncommon for many physicians in this situation to complete a robust office day and then spend the evening and overnight hours on-call.

Many are reluctant to curtail office hours during the daytime. They feel compelled to keep pace with routine practice hours to meet patient demands and to maintain income.

The Risk Exposure

Fatigue can lead to serious consequences, including medical errors and malpractice. Health care facilities have a

responsibility to patients to maintain quality care and to avoid patient safety problems. Permitting fatigued practitioners to care for patients may be seen as negligence, and staffing problems will not be an adequate defense. The upshot may well be litigation directed at the physicians themselves and health care organizations that permit such practices.

Strategies for Reducing Risk Exposure

Leadership of health care organizations can take steps to reduce the risk of fatigued practitioners caring for patients. It is a shared responsibility of the chief medical officer, department heads, and the leaders of the medical staff. Some strategies include: 1 Reduce continuous hours on-call. Instead of being on-call from early evening until the next morning, consider splitting the time period between two practitioners. While the early evening practitioner is on duty, the “overnight” practitioner could sleep and be rested for the “swing shift” hours.

hospitalists to provide medical services in the evening and overnight hours.

5 Make the setting accommodating.

Consider a designated on-call room replete with computerized access, kitchen, and bedroom amenities for on-call specialists.

Accommodations that help with power naps and rest periods help to sustain a rested, alert practitioner.

Conclusion

Fatigue is a known serious risk exposure in patient care. It is a risk that can be managed through thoughtful changes to the delivery of health care services.

Enlisting the help of those on the front line of the issue—the medical staff—is imperative to positive change. Providing medical leadership with useful strategies to start the process will help to enhance patient safety.

AAMC Policy Guidance on Graduate Medical Education – Assuring Quality Patient Care and Quality Education.

2 Provide education. Provide the October 2001. medical staff with practical education about the fatigue factor. Consider using lessons learned This literature is descriptive only. It is from other industries to reinforce the offered as a resource to be used in maintaining a loss prevention program. This literature is necessarily seriousness of the issue.

3 Modify the medical staff bylaws. Encourage the medical staff to remove obstacles to change by revamping outmoded terms and conditions in the bylaws or practice routines that insist on unacceptable on-call hours.

general in content and intended to give an overview of certain aspects of health care liability in the United States.

It should not be relied on as legal advice or a definitive statement of the law in any jurisdiction. For such advice, applicants, insureds, or other readers should consult their own legal counsel. No liability is assumed by reason of the information this document contains.

This publication may present brief overviews of liability exposures. Claim examples are based on actual cases, composites of actual cases, or hypothetical situations. Whether or not or to what extent a particular loss is covered depends on the facts and circumstances of the loss and the terms and conditions of the policy as issued.

Reprinted with permission of from STAT, Chubb’s Health Care Newsletter. Chubb Group of Insurance Companies, Warren, NJ

4 Think about staffing options for the swing shift. Encourage large group practices to designate a member of the group to be the “on-call hospitalist” for a set period each month. Large groups are most able to adjust patient load while maintaining revenue stream to accommodate one member being the on-call hospitalist for a few days each month. In other situations in which health care organizations do not work Chubb Group of Insurance Companies Warren, NJ 07059 http://www.chubb.com STAT Newsletter with large group practices, consider the idea Edition 4, 2004 of hiring specialized physician assistants or

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Membership Reports President – Paula Willoughby DeJesus, D.O., FACOEP The constitution is the guiding tenants and structure of our organization. It provides for the foundation of how we see emergency medicine in its preamble, our vision; the purposes of our organization, the mission and its articles are then the structure in accomplishing these important processes.

As I look at what I should prepare to tell you about the current health and progress of our College I turn to the constitution to clearly define my role and responsibility to you. I am to “exercise general charge and supervision of the affairs of the College, and will do and perform such other duties as assigned to him or her by the Board, or permitted or provided elsewhere in these bylaws. These other duties include presiding at this meeting, appointing an assistant to the Office of Secretary as needed, express the decisions of the Board to members on ethical violations of the College and appoint the College Committee members.

It is this meeting and our Committee processes we have been focusing on as a Board over our first 5 months as a team.

The first priority was the Committees.

Committees are the fundamental unit of structure for our organization. Committees are the structure that assembles the building blocks. Members are the building blocks.

Committee leadership shapes and orchestrates the interaction of the building blocks that ignite the intellect and the talent that create the work product of the Committee.

Choosing the Committee leaders to include a Chair and Vice-Chair for each Committee was pivotal. They had to be from the membership. These would be the individuals driving the force behind the Committees. These leaders were chosen in group process by the Executive Committee of the Board, not just presidential purview. It needed to reflect the philosophy that the Board would function as a team and the team represented a member driven organization. With this in mind, we took

on another new approach. We empowered the Committee Chair and Vice-Chair to put their own team together for each Committee instead of a prescribed presidential list.

In the same spirit, the Board of Directors were charged to identify their expertise and interest in which Committees they would like to serve as liaison.

Our next charge was to create an environment and meeting process that would synergize the ignited potential of the group and give rise to a new level of Committee productivity. To accomplish this we needed to change the how Committees spent time when face to face and how they related to the Board. We entered into a Board retreat to look at our processes, internal relationships and ourselves. From this we have revised the Board agenda to have the Board liaisons provide the Committee updates while the Committee Chairs have direct contact with the members for updates in the membership meetings. The information flows from the Committee Chair/Vice-Chair to the Board liaison and then to the Board and the process is no longer duplicative. It puts the right people in contact with each other. It puts the right work in the right places. The development and implementation in the Committees. The decision making, integration and overall College planning in the Board.

Both groups have more time for their complementary roles and are more appropriately connected.

To kick all of this off our College hit another milestone. We conducted our first ever Committee and Liaison Orientation meeting. The Board met with the Committee leaders and liaisons to discuss performance and conduct expectations. We outlined the leaders’ roles and responsibilities, College relationships and structure and work processes. We provided them with the booklet, “Enhancing Committee Effectiveness” and a disc containing materials on Committee and liaison information on function, composition, planning, report templates and rules of order. We provided the Committee leaders with their current

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goals and objectives and charged them with directing the Committee through a review process that would update these goals and take them out in detail to their implementation steps. A similar orientation process will be developed for new Board members. We have begun to provide new Board members with leadership materials to learn their role with distributing Howe’s book, “Welcome to the Board” and the leadership issue of the journal, Association Management. These processes will give the College a higher functioning Chair, Vice-Chair and Committee. It is these more developed and professionally sophisticated leaders that we should look to as our future Board. I am excited about the possibilities that this hold for us.

Our College is continuing to establish its position as the building block of emergency medicine. The liaison relationships we have developed have put us in a new arena. In the past we have sought these representative roles. Today we are now the one sought. The American Heart Association requested we send a member of our College to their proceedings on the next iteration of revisions to BCLS, ACLS and PALS. I would like to thank Dr. Robert Biernbaum for fulfilling this role on our behalf. There is much ahead of us but the quality of people I see in this room will allow us to meet any challenge put before us.

President-elect – Peter A. Bell, D.O., FACOEP January: Planned for DO Day on the Hill - Worked with Leigh Ann Fox (AOAWashington Office) February: ACOEP BOD Retreat - Reviewed current Strategic Plan - Developed revised Strategic Plan with restructure proposal for growing organization.

ACOEP Program Directors Workshop - Presented AOA 7 Core Competencies with emphasis on OPP Council of Osteopathic Specialty Societies (COSS) - Discussed AOA BOT resolutions

- Approval of additional funding for two meetings per year - Discussed direct reporting to AOA BOT resolution - Discussed alternate proposal and selection of representative by specialty college - Proposed adding Exec Dir as non-voting, self funded representative AOA Bureau of State Government Affairs meeting - Discussed model legislation - Discussed PLI - Expert Witness Policy Federation of Osteopathic Specialty Organizations (FOSO) - Discussed future of organization in light of COSS - Reviewed AOA BOT resolutions AOA BOT Mid-year Meeting - Representation of college interests (see resolution review) Osteopathic Political Action Committee - Attended Chairman’s Club reception March: Prepared OPP Powerpoint CDs for Program Directors - Distribution at the beginning of April Planned for DO Day on the Hill - COSS reception cancelled - Mobilized 65 Ohioans Interview with “ED Management” editor - HIPAA in the emergency department setting ACOEP Spring Seminar Ongoing Facilitating ACOEP and Ohio ACEP dialogue - Consideration for joint CME venture - Robert Jones, DO has formally offered his services to put on Ultrasound Course Facilitating EM Club leadership; set up guest speakers series - Quarterly speakers from Ohio’s Osteopathic EM residencies to OUCOM - Annual speakers from Ohio’s Osteopathic EM residencies to LECOM, WVSOM, VCOM, PCSOM, CCOM ACOEP Committees Executive; Finance; Governmental Affairs; GME; Nominating; OMM; Publications; Program Directors; Resident Chapter

Deborah Pryce Frequent interface with AOA Washington Office Frequent lobbying at Ohio State House (OOA, OHACEP) Working relationship with State Representative Larry Wolpert and State Senator Steve Stivers AOA BOT Resolutions Summary All resolutions were reviewed with COSS, FOSO, ACOEP Executive Director Janice Wachtler, and President Paula WilloughbyDeJesus. Appropriate discussion points were formulated and presented at the AOA BOT Mid-year meeting (Reference committees and open forum). Certain resolutions remain an ongoing concern.

time PAID faculty appointment” at a COM. Added “AOA staff who hold a graduate degree”. Further amended to include “AOA component society staff ”. Language clearly expanded the individuals that may present CME and count as “osteopathic”.

Certification Credit, Non-Osteopathic; allows DOs certified by ABMS to receive 15 hours of Category 2 credit. ACOEP still working to get Category 1 credit for our COLAs.

Expert Witness; general discussion at BSGA regarding time after residency by which a physician is considered an expert.

Consensus was to leave current 3 year post residenct time frame, but add language to accommodate sub-specialty residency that 39 reports from 13 departments were specifically prepares a physician to be an exreviewed pert witness (ie. forensic pediatrics) 1 report from the AOA Research Strategic Direction was reviewed Hospital Closure, Financial Assistance 60 resolutions were reviewed to Trainees; great idea with a lot of concern as to who should fund it (ie bankrupt hospiResolutions for concern: tal, OPTI, specialty college, state or national Critical Care Medicine Training organization) Standards Revisions; EM, Anesthesiology, and Surgery joined their voices to object to IMs Concept of Free Dues to AOA assumption that only IM residency trained Members; withdrawn due to huge financial and physicians should be eligible to train in potential negative political impact critical care. ALOT of discussion. The issues of critical care practice in the ER due Osteopathic Rural referral Center to overcrowding, boarding patients in the (ORRC); redefined to include that a DO ER, lack of staff, and a major change in must be practicing on staff in order to meet practices and patient acuity were discussed. definition. Hospital stands to gain millions of Critical care is critical care no matter where additional dollars. it is practiced or by whom it is practiced.

Due to limited resources there are few COSS, Change in Reporting Structure; Osteopathic Critical Care fellowships. assures that the council reports to the AOA Suggestion was to combine resources BOT instead of the Bureau of Education and work together to meet the changing educational needs of the 4 specialties.

Proposed Amendments to the Handbook of the Bureau of Osteopathic Specialists; EM/IM Residency Training Basic Stan- essentially would allow AOA members to dards Revisions; discussion/compliments obtain their 50 hours/year of specialty CME regarding EM requirements for faculty. We by attending non specialty conferences. are leading the way in higher educational It has the potential to injury the specialty standards. college CME programs and not support the intent of the specialty college CME rePolitical Activities OPTI Revisions; better defined author- quirement. After much discussion, a task Meetings with US Senators George Voinov- ity, oversight, and reporting requirements. force was formed to review the unintended ich and Mike DeWine consequences.

Attend Installment Ohio Supreme Court Category 1 CME Sponsors- Revisions to Membership Reports Chief Justice Thomas Moyers the AOA Accreditation Requirements; addContinued on page 10 Correspondence with Congresswoman ed the phrase “MDs or PhDs who hold a full

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Guest Contributor

Joseph Dougherty, D.O., FACOEP

Geriatric Emergency Medicine:

A Subspecialty or A Need for Increased Knowledge A 79-year-old female presents with nausea and weakness. A 76-year-old female is brought from an extended care facility because she is more confused. A 66-yearold male presents from home with chest pain. An 82-year-old female brought to emergency room with hip pain from a fall.

A 72 year old male as not been able urinate.

These are our patients of the future and present and the numbers will be increasing.

We will need to assess them like we do all our patients. Is treating the elderly patient different than the normal adult patient?

Internal Medicine and Family Practice have recognized that they are. The question is, do we?

The College recently formed an adhoc committee to evaluate the interest and need to develop a subspecialty for Geriatrics. The American College Of Osteopathic Emergency Physicians is not alone; the American College of Emergency Physicians is also exploring this possibility. This isn’t hard to consider since other specialties now recognize there are differences in this patient population from the adult patients we see in the emergency department. The question may be whether or not an emergency medicine subspecialist is needed for this field or we need a group of physicians in emergency medicine who are dedicated to increasing our knowledge base for this patient population.

The ad-hoc committee with the help of the College attempted to survey the graduating residents to determine if there was interest in creating a subspecialty area in geriatric emergency medicine. Eleven physicians responded. Not much of a response I admit, but what was interesting was some the comments. “Don’t we see enough of these patients, they’re dumped off and no one wants to take care of them, their family, friends and sometimes primary care physicians.” “We need to focus on other things like getting more residency

programs” and “I doubt that I would have much interest in taking on the field of frustration and abandonment.“ These statements, believe it or not, are not new to me as assistant chair of the committee.

The comments are not very positive, I know, but the comments tell us that the geriatric patient, defined as the population of retired or over 65 years of age, are difficult patients to care for. They require more time and energy on the part of the emergency physician and resources to take care of them are not always available. I volunteered for this committee for this very reason. It is more interesting to be part of new developing field and providing knowledge and resources when there are few already out there.

There is a growing population we will be treating out there and many us will eventually be part of that population. We will want good care and innovations that help us be cared for. Twenty percent (20%) of the population of the United States will be over 65 years of age by the year 2030. Nine million will be over age 85. The majority these patients have chronic medical conditions and are on numerous medications.

People over the age of 75 visit the Emergency Department twice as often as the younger population. They are more like to arrive by ambulance and to be admitted to the hospital. These are addition factors and emphasize the need to be more knowledgeable about the people I, as an emergency physician, will be treating. Further, I would like to see emergency medicine residents have the knowledge to treat these patients without becoming frustrated.

Caring for the elderly patient can be enjoyable and rewarding. I know because I did it for seven years as assistant medical director for Father Murray’s Nursing Home in Warren, Michigan near Detroit. I worked the Emergency Department night shift and rounded the nursing home in the morning. It was a demand-

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ing task; the patients were not simple and had complex problems. The facility could do a lot for a skilled nursing facility (SNF), sometimes known to us as Extended Care Facility. It offered continued care for patients with rehabilitation needs examples being post hip surgery care, stroke, pneumonia or cardiac illness with debility, and patients with dementia. My residents at the time thought that on weekends and holidays the nursing homes unloaded their patients due to staffing and paranoid families would find out how uncared for their love ones were. I took it upon myself to dispel some of the myths about these facilities and the conditions of the patients they take care of. I felt that after a few lectures explaining the working of the facilities to the residents, sometimes on an individual basis the residents came to an appreciation and had more respect for the patients, the facilities and the physicians providing their care. If you haven’t guessed I am one those combined Internal Medicine/Emergency Medicine residency graduate members of our college. (I like to think that it is truly an Osteopathic concept as the residency represents the continuity of care in the medical community).

It is with these feelings and inner workings of mine and the above facts present to the profession the concept that a subspecialty in geriatric emergency medicine or a group of persons with a special added certificate of qualification recognizing increase knowledge and study of the geriatric population is needed to provide the college membership with better means to provide care to them.

Membership Reports Continued from page 8

of whom have stated that they will rejoin, and for the most part, they have responded. Additionally, letters have been sent out Treasurer – to all those to whom I have called and left Joseph J. Kuchinski, D.O., FACOEP messages but have failed to reach. These

letters contain a letter from me and This is a review of the income and another dues notice. expenses for the fiscal year of 2004-2005 in comparison to the budgeted amounts We are working closely with for this period.

Dr. Sturkie to ensure that we make a

special effort to contact those members who Revenue: are made new Active Members. It appears Membership that many are holding off paying dues to see Dues (7.2%) what organizations give them the most for their money. We will need to make a special CME Programs effort to inform these new graduates what Scientific Assembly TBD ACOEP offers them. We will be working Intense Review 27.3% with the Membership Committee to formuCola Essentials 17.5% late appropriate letters and / or brochures that illustrate this for our dues mailing in Advertising (45.3%) August.

The office has begun researching the AOA GME Compensation (91.4%) insurance market for agents who may be able to handle member’s inquiries in life, Resident Examination (1.5%) health, and even malpractice issue policies.

We have learned that for the most part no Expenses: one agent is ever licensed in all 50 states and at best we will have to develop relationships Administrative with regional firms. We will continue to Postage and Mailing 74.8% investigate this and report back to the Membership Committee.

CME Programs The membership of the ACOEP stands Scientific Assembly TBD at 1983 of which 1436 are Active (72.4%); Intense Review 21.6% 471 are Resident Members (23.7%); 59 Cola Essentials (5.8%) are Intern Members (2.9%); 13 are Life [Printing 100% and Mailing 300% over] Members (.6%), and 4 are Honorary Members (.2%).

Board of Directors 82.9% Committees

Liaison Activities.

In February, Ad Hoc $1,515.53 Dr. DeJesus, Dr. Bell, and myself attended Misc. $7,883.55 the Mid-year meeting of the AOA Board of Trustees. This meeting dealt with actions Executive Director – Janice Wachtler taken by AOA Committees during their Fall This report covers the period of Decem- meetings. The one issue that may have the ber 1, 2004 through March 15, 2005 and most impact on ACOEP and other specialty deals with the activities of the Association. organizations was Res. 54 which dealt with re-entry into the certification process and Membership. As of February 1, 2005, would allow physicians entering this prowe had approximately 80 physicians who cess or preparing for recertification to gain had not renewed their membership. This is Category 1A credit by completing genapproximately 5.5% of the active mem- eral AOA courses, like the Scientific Semibership. Despite distributing the list of nar, without registering as a specialist and members to the Board members and my gaining full specialty credit. The specalling each member individually, the cialty colleges present gave rationale why response has been minimal. I have spoken this should not be passed and it was sent with approximately 20 of the physicians all to a special task force. We have notified

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AOBEM of the ramifications of passage of this and have asked for their support should this come before BOS this spring.

Affiliate Reports Student Chapter – Jeremy Selley, President Greetings from the Student Chapter! The ACOEP Convention is here and the Student Chapter is excited to officially participate for the first time in the ACOEP Committees. Twenty plus students are scheduled to attend the convention activities this year, double the numbers from last year.

Five months have passed since the San Francisco AOA Convention, but the Student Chapter officers are still very excited and motivated to continue the success of the Student Chapter into the 2004-2005 school year. Here are the Student Chapter officers: President Jeremy Selley, MS-3 KCOM acoepsc_pres@hotmail.com Vice-President Brian Kostuk, MS-3 DMU acoepsc_vp@hotmail.com Secretary Mike Remley, MS-3 UNECOM acoepsc_sec@hotmail.com Treasurer Josh Linebaugh, MS-2 KCUMB Acoesc_treas@hotmail.com Constitution & Bylaws Committee Chair C. Bridget Evans, MS-2 WVSOM cbevans@wvsom.edu Graduate Medical Education Committee Chair Joshua Botdorf, MS-3 KCOM jbotdorf@atsu.edu Osteopathic Medical Explorers Program Committee Jim Meissen, MS-2 OSUCOM Jim.meissen@okstate.edu Membership Reports Continued on page 12

Guest Contributor

Wayne Jones, D.O., FACOEP Chair, EMS Committee

The National EMS Scope of Practice Model Posted for Review: Importance for all Practitioners For those of you in the EMS community following the Scope of Practice development

by The National Highway Traffic Safety Administration (NHTSA), the second draft has been posted. For those of you who have no idea what I am talking about, here it is.

Many of you may recall the presentation by Robert Suter, DO, a few years back, detailing NHTSA’s EMS Agenda for the Future. The vision was to see a new, integrated and responsive EMS system by the year 2010. To quote the agenda, “(EMS) will be community-based health management that is fully integrated with the overall healthcare system…. This new entity will be developed from redistribution of existing healthcare resources and will be integrated with other healthcare providers and public health and public safety agencies.” By January 1998, a separate committee was established to revise this document and recommended advancing this concept through education. This task force represented the full range of professionals involved in EMS education. The NHTSA EMS Education Task Force (now named) penned the EMS Education Agenda for the Future. Upon its completion, the group endorsed five inte-

grated components of education; National EMS Core Content, National EMS Scope of Practice Model,

ical responder (EMR), emergency medical technician (EMT), advanced emergency medical technician (AEMT), and paramedic. Though they may National EMS Education Standards, sound similar in name to those we are National EMS Education Program currently familiar with, do not look for the Accreditation, and National EMS same skills (or names) to be present as they are Certification today. I am sure all of you would like a brief review of each level and skill requirement, The Scope of Practice Model project be- but by the time this article goes to print, the came the second step in implementation of the standards and language may change. The five-component EMS Education Agenda for intention is to improve consistency of EMS the Future. NHTSA and the Health Resourc- personnel levels and nomenclature. The es and Services Administration contracted document itself (when completed) will have with the National Association of State EMS no regulatory authority but will form the Directors to lead the project, assist- basis for EMS regulation, which is now ed by the National Council of State controlled by each state.

EMS Training Coordinators. A first Draft 2.0 The National EMS Scope draft was posted late 2004 and the of Practice Model is currently available comment period ended just prior to the on www.emscopeofpractice.org. I would ACOEP Spring Seminar. A second draft of the encourage anyone interested in the scope of practice document is now posted on final outcome to log on and form your own www.emsscopeofpractice.org. opinion. There is currently a comment What does this document do for EMS? It period open until June 1, 2005. By the time attempts to define the national levels of EMS of this publication the comment period providers including their entry level skills may be closed but you will still have the and knowledge. The current document post- opportunity to inspect the latest version and ed on the web site includes emergency med- follow the process.

Avis, Always Providing New Ways To Save You Time and Money.

Your membership in the Avis Association Program entitles you to a host of special Avis services and discounts that can save you lots of time and money.

What’s more, you’re eligible for savings up to 10% off Avis Association Select rates and 5% off promotional rates at all participating locations. Shop around. You’ll find Avis has very competitive rates. And with the Avis Wizard System, you can receive our best available rate when you mention your ACOEP / Avis Worldwide Discount (AWD) number: T024500 Isn’t it a relief to know that Avis moves just as fast as you do? For more information and reservations, call 1-800-331-1212. And remember to mention your ACOEP / Avis Worldwide Discount (AWD) number: T024500

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Membership Reports Continued from page 10 Convention Committee Co-Chairs Paul Duscher, MS-2 DMU Paul.b.duscher@dmu.edu Sherry Turner, MS-2 NSUCOM sherturn@nova.edu PR Committee Co-Chairs Adam Lee, MS-2 CCOM Adam.lee@mwumail.midwestern.edu John Lavelle, MS-2 CCOM John.lavelle@mwumail.midwestern.edu Past President Nicky Ottens, MS-4 CCOM Nicole.otten@mwumail.midwestern.edu

participate in this presentation and provide a brief talk on any aspect of Emergency Medicine.

As the Student Chapter looks to the future, we would like to expand our mentor list among the members of the college for future student use. This mentor list would be used by the Student Chapter to match ACOEP members with Student Chapter members based on geographical location.

Students need encouragement, guidance, and support to help become an Emergency Physician, so please contact the ACOEP office or e-mail me at acoepsc_pres@hotmail.com if you are interested in becoming a mentor.

The Student Chapter is always open to ideas you may have to help strengthen the Student Chapter by providing additional resources or activities, so please feel free to contact us! Thank you to ACOEP and its members for its continued support of the Student Chapter. Without your support we could not function effectively to serve our Student Chapter members; Please don’t forget to stop by our booth to help in our fundraisers! Additionally, the Student Chapter would like to provide a special thank you to Dr. DeJesus, Dr. Oster, Dr. Siberski, Dr. Mitchell, Barb, Jan and Katie for all of their efforts.

Resident Chapter – Julie Johns, D.O., President We continue to be excited at the increased involvement of residents in the Chapter and the College. We have a much larger than usual group attending Spring Seminar this year to participate in committees. Our goal continues to be to increase membership and involvement. We will be meeting during Spring Seminar to discuss the various committee agendas and possibilities for resident involvement, as well as to plan for the next AOA meeting in Orlando.

Specific goals at this time include increased travel funding and residency program director support to attend Chapter meetings as we believe this will further increase resident involvement in the College.

The last year brought change to the Student Chapter as we set out to refine our organization, to improve our level of respect within our profession and nationally, and to take on more responsibility. This year, one major facet the board members are trying to institute is a member fee of $10. The dues are paid once and will provide a four-year membership in the ACOEP-SC. These dues will begin with the incoming class this fall.

All previous classes will be exempted from the dues requirement.

The chapters and individual members will benefit from these dues by: 1. Creation of a student data base that allows easier communication to all members 2. Allowing funds for more student educational activities and programs at the conventions 3. Creating funds for clubs to request funds for special activities 4. Publishing of the Emergent 5. Donating to Foundations for Osteopathic Emergency Medicine (FOEM) for their benefit in the future 6. Providing the schools with recruitment welcome packets. These welcome packets will include copies of The Emergent and The Pulse, tri-fold brochure, and other practical emergency medicine information 7. ACOEP-SC Lapel Pin Foundation for Osteopathic Medicine The Student Chapter has created a power – Janice Wachtler, Executive Director point presentation to be given annually The Foundation continues to make at each College. The Student Chapter is strides to support the research needs of requesting ACOEP member if they would the profession. In the Fall, the Foundation

12

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decided to regroup to achieve more stable sources of funding. It is currently developing a budget history in an effort to develop its first budget and hopes to identify further funding sources and to begin a successful capital campaign.

Additionally, for the first time, the Foundation will be conducting interviews for future Board members. The Board has identified three interested parties who will be interviewed at the next meeting of Board, scheduled for June 11, 2005 in Philadelphia, Pennsylvania.

Liaison Organization Reports American Osteopathic Board of Emergency Medicine – Bryan Staffin, D.O., FACOEP

On behalf of the American Osteopathic Board of Emergency Medicine, I would like to thank you for providing AOBEM with the opportunity to update you on its activities.

With the closing of 2004, AOBEM completed the first year of the new process of Continuous Certification in Emergency Medicine (CCEM). As is expected with change, questions are being forwarded to AOBEM by its diplomats in regards to CCEM. AOBEM expects that the future will bring up additional concerns and questions as our diplomats continue towards recertification via CCEM. AOBEM looks forward to assisting its diplomats in the process of CCEM. AOBEM wishes to thank the ACOEP Board of Directors for allowing AOBEM the opportunity to address these issues via ACOEP publications and ACOEP general membership meetings.

The body of our report is as follows.

AOBEM Examinations 1. Primary Certification in Emergency Medicine 2. Certification of Added Qualifications 3. Continuous Certification in Emergency Medicine Primary Certification in Emergency Medicine Part I The written portion of the primary certification process was offered this past Membership Reports Continued on page 20

AstraZeneca

is pleased to support the

American College of Osteopathic Emergency Physicians AstraZeneca is one of the world’s leading healthcare companies, providing innovative, effective medicines for serious medical conditions.

Skilled research is at the heart of our continuing success and we spend more than $2.7 billion each year on the discovery and development of new and improved medicines.

Our track record of innovation includes leading treatments for gastrointestinal disorders, heart disease, cancer, central nervous system (CNS) disorders, respiratory diseases and pain and infection.

With US headquarters based in Wilmington, Delaware, we are committed to maintaining a flow of new products around the world which protect and improve human health and quality of life.

www.astrazeneca-us.com Š 2002 AstraZeneca Pharmaceuticals LP

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13

research and development organization With 100 years of combined experience, scientists at AstraZeneca have discovered and developed several of today’s leading prescription medicines—pharmaceuticals that contribute to a higher quality of life for millions of patients and to a better health economy worldwide.

Based in Sweden, AstraZeneca’s R&D organization is international in scope and comprised of approximately 10,000 researchers. Through its own resources and through collaboration with dozens of universities and strategic alliances with numerous research and biotechnology companies, AstraZeneca has broad access to advanced technologies in biomedical research, including genomics, bio informatics, chemical libraries, high throughput screening and product delivery systems.

leading with products

AstraZeneca’s success ratio of bringing new

Priority research is being conducted for the

products to market is among the best in

development of treatments for high cholesterol,

the pharmaceutical industry. The company

blood clot formation, lung cancer and other

produces a wide range of products that make

types of cancer.

significant contributions to treatment options and patient care.

With an R&D pipeline that has been recognized as the best in the industry, the company is well

AstraZeneca has one of the world’s leading

equipped to maintain a flow of high quality

portfolios to treat cancer and gastrointestinal

medicines over the coming years. These

disorders, in addition to the areas of anesthesia

medicines will offer improved health and quality

(including pain management), cardiovascular

of life for patients, better health economics for

disease, respiratory and central nervous system

society and attractive growth for AstraZeneca.

disorders.

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The PULSE JULY 2005

AstraZeneca is a major international research

AstraZeneca operates nine different R&D sites

based pharmaceutical company engaged in the

and has sales activities in over 100 countries

development, manufacture and marketing of ethical

and manufacturing facilities in 19 countries.

(prescription) pharmaceutical products. Our long

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heritage of innovation and documented ability to

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develop new concepts in medicine has made us

the U.S. alone.

one of the top five pharmaceutical companies in the world.

AstraZeneca PLC is headquartered in London with its U.S. headquarters located in Wilmington, Delaware. Wilmington is also the global home for the company’s Central Nervous System (CNS) commercial and research and development efforts.

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15

leading in the community and the workplace patient assistance program AstraZeneca is acutely aware of the growing costs of healthcare in the United States. The AstraZeneca Foundation Patient Assistance Program (PAP) (formerly the Zeneca Pharmaceuticals Foundation Patient Assistance Program), which has been in existence since 1978, and the

In addition to its products and research and development efforts, AstraZeneca provides health education information, support services and health guidance to millions of Americans through public awareness campaigns including: • National Breast Cancer Awareness Month • Prostate Cancer Awareness Month • Capitol Hill Briefing Program with Asthma and Allergy Foundation of America (AAFA) • National Alliance for the Mentally Ill (NAMI) Helpline Online

AstraZeneca LP Patient Assistance

• NAMI’s Campaign to End Discrimination

Program provide AstraZeneca products

• Migraine Mentors Program with the

free of charge to patients who cannot afford them and who do not have insurance or other programs that can provide the product. Currently there are more than 250,000 patients enrolled in these programs. Over the past year, AstraZeneca donated medicines valued at over $250 million to indigent patients across the United States and Puerto Rico.

National Headache Foundation • Clinical Outcomes Research Initiative (CORI) with the American Society for Gastrointestinal Endoscopy • Nationwide Asthma Screening Program with the American College of Allergy, Asthma and Immunology (ACAAI) • Human Medicine Symposium Series with the Minority Health Institute While AstraZeneca is committed to educating the public, the business’s commitment to its own employees is equally important. AstraZeneca offers onsite breast, prostate, colorectal and skin cancer screenings as well as preventive health programs for employees in all of our therapeutic areas.

www.astrazeneca-us.com © 2002 AstraZeneca Pharmaceuticals LP

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Resident Research David D. Sakarati, D.O.

Patient Privacy in the Emergency Department – Does it Meet the Patient’s Expectations?

Introduction

Patient privacy is a cornerstone of medicine. Reports have shown that despite knowledge and appreciation of patient privacy, emergency department (ED) personnel often violate this standard of practice.1-7 Privacy is defined as “respect for the confidential nature of the therapistpatient relationship.”8 Patients have the right to have the information they share with their physician kept confidential. 9

Emergency department crowding, architectural designs, and the unique work environment of the ED are reported as factors contributing to breach of privacy.3 The American College of Emergency Physicians Ethics Manual even recognized that patient-physician confidentiality can be difficult because of “an open environment in which physicians, nurses, patients, security staff, police officers, paramedics, and emergency technicians all interact.”10

In 1803, Thomas Percival established the first modern code of Western medical ethics, which states, “Patients should be interrogated concerning their complaint in a tone of voice which cannot be overheard.”11 More recent research has demonstrated that there are differences between the level of auditory and visual privacy of patients located in rooms with solid walls and of patients located in rooms with curtain dividers.1, 3 However, it was shown that there was no difference between these two groups regarding their perception of the amount of privacy that they received or expected to receive from the staff.1

Increased demand for emergency services has extended emergency department visits to over 100 million per year.12 This tremendous growth has led to overcrowding and many emergency departments are forced to place sick patients on gurneys in the hallways awaiting nursing and physician evaluation. The purpose of this investigation was to compare perceptions of privacy between patients located in the hallways,

in solid-walled rooms, and in rooms with study, obtained consent, and answered any curtain dividers. questions that arose regarding the survey.

The survey consisted of 10 questions Methods that were modified from Barlas et. al.1 The

The study was conducted at a univer- survey did not contain any patient identisity affiliated community teaching hospital fiers other than age and gender. The rewith over 80,000 ED visits per year. The spondents were asked to rank their answers hospital institutional review committee to privacy questions on a 5-point Likert approved all aspects of the study prior to scale from one (least private to very poor) data collection. Informed consent was to five (most private or excellent). Patients obtained from each patient before reviewing were offered the survey after they had been the survey. evaluated by a physician and before dis The study ED is divided into twelve charge from the ED. The investigator made curtained rooms (rooms 1-3, A-I), four efforts to conceal the topic of the study from solid-walled rooms (rooms 4 –7) and up to the other residents and staff members to three hallway beds (Hall 1-3). The hallway reduce participation bias and the Hawthorne beds are typically utilized when the other effect. Data was collected and analyzed rooms have been filled or the patient does using SPSS statistical software. Descriptive not require a cardiac monitor. statistics were used for simple frequency

The study was conducted over a data and Chi Square analysis was evaluated five-month period (September 2003 to difference between groups.

January 2004). Surveys were given to patients located in the halls reserved for the Results higher acuity patients of the ED at vari- Three hundred and four (304) patients ous times of the day. Patients that were in were available during the study period. the trauma bays were excluded from the Of these patients, 163 were eligible and study as well as patients in the lower acuity the remaining 140 met one or more of the areas of the ED. Additionally, patients were exclusion criteria and were not surveyed. excluded if the survey interfered with their The data was collected between 0900 and medical care, if the patient was a minor, 2300 with 69% collected between 1400 could not read or comprehend English, was and 2000. Sixteen percent of the data was incompetent to consent, refused to partici- collected between 0000 and 12000 and pate, or if the data collector was the patient’s 84% between 1201 and 2359. physician.

Patients were designated as those

All eligible patients (curtain, solid- located in curtained rooms, in solid-walled walled, hallway) were surveyed at the same rooms, or in the hallway. 111 (72%) of the time for each day that data was collected. eligible patients were in curtained rooms, A survey period was conducted only once 33 (20%) in solid-walled rooms, and 13 in any 24 hour period. Data was collected (8%) in the hallway – roughly correspondduring 22 different days during the study ing to the proportion of beds (63%, 21%, period by convenience sampling. Data and 17% respectively) for each designated was collected each day of the week and treatment area in the ED. during both daylight and evening hours over Overall, there were 69 (42%) mail the five-month period to obtain a diverse subjects, 90 (55%) female subjects, and sample. Patients were approached by either in 3% gender data was not collected. 53 a junior (author MT), or senior residency male patients and 59 female patients were (DS) who explained the purpose of the in curtained rooms, 7 male and 24 female

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Table 1. Aggregate response of eligible patients located in curtained rooms, solid-walled rooms, and in the hallway.

Survey Questions % probably yes or yes response 1. Did you feel others could hear your conversation with a health care provider?

55% 2. Did you feel that your personal information may have been overheard by others?

48% 3. Did you hear other patient’s conversations with a health care provider?

57% 4. Did you change or withhold any information from your health care provider because you felt it might be overheard by others?

1.2% 5. Did you feel that unauthorized persons may have seen personal parts of your body while in your treatment area?

5.5% 6. Were you able to see personal parts of other patients while they were in their treatment area?

3.7% 7. Did you refuse any part of your physical examination because you felt it might be seen by unauthorized persons?

0.6% % average or better response 97.6% 96.9% 94.5%

8. For this visit, rate how well the emergency department staff respected your privacy.

9. For this visit, rate your overall sense of privacy.

10.For this visit, rate how well your expectation of privacy was met.

Table 2. Comparison of patients’ responses between patients who are located in Curtained rooms, solid-walled rooms, or in the hallway Survey Questions

P-Value Probably Yes/Yes

% Curtain

% Solid

%Hall

0.004 0.000 0.003

64 57 67

22 27 25

62 23 62

0.898

1.7

0

0

0.627

5.1

6

7.4

0.341

2.5

6.0

7.7

1. Did you fell others could hear your conversation with your health care provider?

2. Did you feel that your personal information may have been overheard by others?

3. Did you hear other patient’s conversations with a health care provider?

4. Did you change or withhold any information from your health care provider because you felt it might be overheard by others?

5. Did you feel that unauthorized persons may have seen personal parts of your body while in your treatment area?

6. Were you able to see personal parts of other patients while they were in their treatment area?

7. Did you refuse any part of your physical examination because you felt it might be seen by unauthorized persons?

8. For this visit, rate how well the emergency department staff respected your privacy.

9. For this visit, rate your overall sense of privacy.

10.For this visit, rate how well your expectation of privacy was met.

patients were in solid-walled rooms, and 6 male and 7 female patients were in the hallway. The mean age of all patients was 53 years old. Patients in curtained rooms had a mean age of 58 years old, patients in solid-walled rooms 50, and hallway patients 46 years old.

All surveyed patients’ responses to privacy questions are summarized in Table 1. Patients felt that they could hear others or others could hear their conversations 48 – 57% of the time. In contrast, only 3 – 5% felt that they could see or other could see personal body parts during their emergency department visit. Overall, about 94% of the patients in the survey perceived that their privacy was average or better, regardless of their location in the ED. Two patients in curtained rooms reported that they changed or withheld information because they felt others might overhear it. One patient in a curtained room reported that they refused part of a physical exam because they felt other persons might see them.

18

0.636 0.609 0.104 0.002

Table 2 shows a comparison of patients’ responses between those patients who are located in curtained rooms, solid-walled rooms, or in the hallway. Questions 1, 2, 3 and 10 were found to have a significant difference between groups. Fewer patients in solid-walled rooms (22%) versus in curtained rooms (64%) felt that the others could hear their conversations with their health care provider (p<0.004). More patients in curtained rooms (575) felt that their personal information may have been overheard by others than those in the other treatment areas (solid-walled 27%, hallway 23%) (p<0.000) Fewer patients in solidwalled rooms (25%) heard other patient’s conversation compared to those located in curtained room (67%) and in the hallway (62%) (p<0.003). Finally, there were a smaller percentage of patients who felt that their expectation of privacy was average or better in the hallway (92%) compared to those in curtained rooms (96%) and in solidwalled rooms (100%) (p<0.002).

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0.8 0 % Average or Better 97 100 97 100 96 100

0 100 92 92

Discussion

Most Emergency Departments have patients who are cared for on gurneys in the hallway. Further, more patients are being crowded into rooms with curtain dividers and the inherent noises level and opportunities for privacy breaches are greater in crowded environments. In the study hospital, in fact, there are only four solidwalled rooms designated as treatment areas in the high acuity area of the emergency department. Thus cramped conditions have become the reality in the era of increased demand for emergency services and subsequent ED overcrowding.

Despite crowded conditions, it is still the emergency physician’s duty to provide a high degree of privacy and maintain confidentiality for the patients in their care.

Since the Hippocratic Oath was written in the fourth century BC, physicians have been expected to protect the privacy and confidentiality of their patient interactions.

The Pythagoreans wrote, “Whatever in my

practice or not in my practice I shall see or hear amid the lives of mean, which ought not be noised abroad, as to this I will keep silence, holding such thing unfitting to be spoken.”4 Maintaining patient privacy instills trust between the patient and the emergency physician. Current regulations mandate hospitals to ensure patient privacy. The Joint Commission on Accreditation of Healthcare Organizations Hospital Accreditation Standards manual, mandates the “the built environment provides appropriate privacy to patients.”13

Our data suggests that despite a large percentage of reported auditory privacy violations (48-57%), the majority of patients overall felt that the emergency department staff respected their privacy average or better (97.6% of patients), that their overall sense of privacy was average or better (96.9%), and that their expectation of privacy was met average or better (94.5%). There was a significant difference between groups regarding auditory privacy. Patients in the solid-walled rooms were less likely to feel that others could hear their conversations.

This was expected, as the solid-walled room would likely give the greatest degree of privacy. Interestingly, patients in the hallway had similar (23%) responses to patients in the solid-walled rooms (27%) when asked if they felt their personal information may have been overheard by others. It would be expected that patients’ responses in the hallway would have been more similar to those patients in the curtained rooms, which were indeed significantly higher. With the large number of auditory privacy violations, one can surmise that regardless of treatment area, healthcare providers need to be cognizant of the amplitude of their conversation with their patients and with each other.

Further, reported visual privacy breaches were a relatively small number. Our data shows that 5.5% of all patients felt that unauthorized persons might have seen personal body parts and 3.7% report that they were able to see other patients’ personal body parts. However, there was no significant difference between the three subgroups of patients regarding visual privacy breaches, no was there any difference between groups in terms of refusing any part of their examination because of fear of unauthorized persons seeing them.

Often curtains are not closed properly or are frequently opened and closed during a patient’s visit in the ED. Many non-physician healthcare workers enter and exit patients’ rooms including laboratory and radiology personnel, social workers, nurses, and medical, nursing and EMT students.

Siegler goes as far to say that confidentiality in medicine is a “decrepit concept” as more than 75 people in an informal survey he conducted had access to his patient’s medical chart.14 In this study, the one patient who reported “possibly yes” regarding exam refusal was in a curtained room and no hallway patients refused exam despite having virtually no visual or auditory privacy.

Finally, despite auditory and visual privacy breaches in all treatment areas, generally patients rated their overall sense of privacy very highly (average or better) and felt that the emergency department staff respected their privacy at least average or better. There was no significant difference between the three treatment areas in these regards. Patients in the solid-walled and curtained rooms had their expectation of privacy met significantly better than those in the hallway, although al three groups had very high satisfaction scores in meeting their expectations.

Barlas et al reported similar findings in their study that compared patients in curtained areas and patients in solidwalled rooms. They found 85% of all patients (n=115) perceived that the ED staff rendered “complete” or “a lot of respect for privacy and found no significant difference between the different treatment areas.”1 Olsen reported 36% of all patients in his study overheard conversations, but found no difference based upon whether they were in a curtained room (37%) or a solid-walled (32%).2 Overall, patients in their study agreed that their ED visit was “private and confidential.”

Previous research has shown that healthcare workers frequently make privacy breaches both in the emergency department and in other areas of the hospital. Mlinek reported in a prospective observational study of medical personnel in a university emergency department that all members of the heath care team – attending physicians, residents, medical students, nurses, paramedics, clerks, volunteers, and other ancillary personnel-committed visual

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breaches.3 He reported that rooms with solid-walls and doors did not allow for any breaches in confidentiality or privacy but with the “curtain walls” almost everything could be heard by an observer in the next room. Ubel et al studied inappropriate comments were made.6 The most frequent comments were violations of patient confidentiality (50%). It has been reported that patients in fact have a stricter definition of confidentiality than do their physicians.15 Limitations

There were several limitations of this study. Nearly half of the patients present during the survey periods were excluded based on pre-determined criteria. Another limitation includes the small number of hallway and solid-walled survey subjects. During the survey period, the hospital made a great effort to keep patients out of the hallway in response to the new HIPPA regulations. Finally, patients seeking medical attention who are presumably ill and more vulnerable may respond to survey questions differently than healthy patients who complete questionnaires under different circumstances.

Conclusion

It is paramount that physicians maintain patient privacy and confidentiality. Despite architectural limitations and emergency department overcrowding, physicians must strive to deliver quality patient-centered care that respects privacy. This study demonstrates that patients a high degree of privacy whether they are located in a room with solid-walls, curtains, or on gurney’s in the hallway even though visual and auditory breaches are not uncommon.

Bibliography 1. Barlas D, Sama A, Ward MF, et al. Comparison of the Auditory and Visual Privacy of Emergency Department Treatment Areas with Curtains versus Those With Solid Walls. Ann Emerg Med. 2001;38:135-139.

2. Olsen JC, Saben BR. Emergency Department Patient Perceptions of Privacy and Confidentiality. J of Emerg Med.2003; 25:329-333.

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3. Mlinek EJ, Pierce J. Confidentiality and Privacy Breaches in a University Hospital Emergency Department. Acad Emerg Med. 1997, 4:1142-1146.

4. Larkin GL, Moskop J, Sanders A, Deras A. The Emergency Physician and Patient Confidentiality: A Review. Ann Emerg Me 1994; 24:1161-1167.

5. Mortlock T. Maintaining patient confidentiality in the A & E. Nurs Times 1994; 90:4243.

6. Ubel PA, Zell MM, Miller DJ, et al. Elevator Talk: Observational Study of Inappropriate Comments in a Public Space. Am J Me 1995; 99:190-194.

7. Flegel KM, Lant M. Sound privacy for patients. CMAJ 1998; 15:613-614.

8. Hensyl W: Stedman’s Medical Dictionary, ed 25. Baltimore, Williams and Wilkins, 1990, pp 341, 1258.

9. Knopp RK, Satterlee, PA. Confidentiality in the Emergency Department. Emerg Med Clinics of N Amer. 1999; 17(2):285-396.

10.Sanders AB, Derse AR, Knopp R, et al.

American College of Emergency Physicians Ethics Manual. Ann Emerg Med. 1991; 20: 1153-1162.

11.Leake CD (ed): Percival’s Medical Ethics.

Baltimore, Williams and Wilkins, 1927.

12.Derlet, RW. Editorial, Overcrowding in Emergency Departments: Increased Demand and Decreased Capacity. Ann Emerg Med. 2002; 39(4): 430-432.

13.2003 Hospital Accreditation Standards.

Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations.

EC.3.3, p239.

14.Siegler M. Confidentiality in Medicine – A Decrepit Concept. N Eng J Med. 1982; 307 (24): 1518-1521.

15.Weiss BD. Confidentiality Expectations of Patients, Physicians, and Medical Students

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Membership Reports Continued from page 12

examination is given yearly at the AOA convention.

Continuous Certification in Emergency Medicine COLA 1 came online in January 2004.

As of March 9, 2005, 227 diplomats have registered for the COLA. The diplomats that have successfully passed the COLA will receive CME via the ACOEP. COLA 1 will no longer be available as of January 1, 2006.

COLA 2 came online in January 2005.

As of March 9, 2005, 47 diplomats have registered for COLA 2.

Part II The oral component of the primary In 2004, 30 diplomats participated in certification process was offered this the formal recertification exam in emergenpast November 2004. 72 candidates cy medicine (FRCE). 29 diplomats passed participated in the exam. 70 candidates the exam for a 96.6 % pass / fail rate passed the exam for a pass / failure rate of 97.2 %. A separate report has been 29 diplomats were recommended forwarded to the ACOEP’s Executive Di- to the BOS for recertification this past rector indicating the pass / failure rate by January 2005. After the BOS’s approval, the diplomats for recertification were presented osteopathic emergency medicine program. to the BOT in February 2005. Upon the BOT’s approval, these 29 candidates were Part III The clinical component of the primary granted 10-year recertification certificates in emergency medicine by the AOA. certification process is currently ongoing.

The candidates that successfully The next FRCE will be offered on Sepcomplete this final component of the primary tember 19, 2005 in Chicago. The deadline certification process will be recommend- for application is May 27, 2005 for those ed for certification by AOBEM to the diplomats that wish to recertify. Diplomats Bureau of Osteopathic Specialists (BOS) this with certificates that expire in 2005 and coming June 2005. With the BOS’s 2006 have been notified by AOBEM of approval, the candidates will then be pre- the FRCE’s availability. In 2006, diplomats sented to the AOA’s Board of Trustees (BOT) with certificates that expire in 2006 and in July 2005 for certification in emergency 2007 will receive notification of the FRCE’s medicine. Upon the approval of the BOT, availability the candidates will be granted certification As of November 1, 2004, there are 1,341 diplomats certified in emergency in emergency medicine by the AOA. medicine by the AOA. Certification of Added Qualifications The Future The CAQ in Medical Toxicology was conducted this past February. One As of this communication, February 2006 will be the last written Part I examinadiplomat participated in the exam.

The next offering of a CAQ in Medical tion for certification in emergency medicine.

Toxicology will be in 2007. The deadline It is expected that in 2007, AOBEM will see the implementation of a computerized Part for application is December 1, 2006.

I examination that will be offered across the The next offering of the CAQ in EMS country at multiple computer centers. In will be in 2006. The deadline for applica- addition, AOBEM is expecting to digitalize a portion of the Part II examination in the tion is December 1, 2005.

A conjoint examination committee un- near future. der the direction of the BOS administers In closing, AOBEM is appreciative of the CAQ in Sports Medicine. AOBEM has the support it receives from the ACOEP. participated in the conjoint examination The mutual cooperation and support the process since its inception in 1996. The two organizations provide to osteopathic February. 147 candidates participated in the exam. 128 candidates passed the exam for a pass / failure rate of 87.1 %. A separate report has been forwarded to the ACOEP’s Executive Director indicating the pass / fail rate by osteopathic emergency medicine program with the intent that this information will be shared with the ACOEP’s Graduate Medical Education Committee.

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emergency medicine will ensure a future ful completion of the required number of of excellence.

Continuous Osteopathic Learning Assessments (COLA). The fourth component is What is………..Continuous fulfilled by the successful completion of the Certification in Emergency Medicine?

FRCE. As of January 1, 2004, the episodic recertfication process in emergency medicine Upon the successful completion of the converted to a 10-year, continuous for- fourth component of CCEM, the diplomat. A diplomat receiving a certificate in mat is issued a new 10-year certification in year 2004 immediately became eligible to emergency medicine by the AOA. participate in CCEM. In the year 2014, this diplomat can than elect to complete their COLA’s recertification by participating in the For- Each COLA is a 40 item web-based mal Recertification Examination (FRCE), exam covering a portion of the core content the fourth component of CCEM. of emergency medicine (see attachment).

Diplomats with certificates that expire References and suggested readings for each prior to 2014 are being phased into the COLA are available at AOBEM’s website CCEM process (see table 1) if they desire to www.aobem.org In addition, these referrecertify. ences and suggested readings are shared CCEM consists of four components with the ACOEP CME committee the year over the 10-year period of continuous certi- prior to the COLA’s offering. fication. The components are as follows: The exam is an untimed, unproctered exam. The exam is intended to be taken at the 1. Evidence of Professional Status convenience of the physician at his or her 2. Evidence of Practice Status own computer. The COLA will assist the 3. Evidence of Participation in Lifelong physician in their review of a specified area Learning of the core content. Each COLA will be 4. Demonstration of Practice Perforonline for two years. The diplomat has three mance and Cognitive Knowledge opportunities to pass an individual COLA though, given the fact that the exam is unThe professional status component is timed and unproctered, it would be unlikely fulfilled by providing evidence of an that the three attempts would be required. unrestricted, unqualified license to practice medicine. The practice status component is FRCE fulfilled by providing evidence of the active The fourth component of CCEM is the practice of emergency medicine or its related one-day FRCE. The FRCE consists of an activities. The third component is abbreviated written exam and an fulfilled by the participation in and success- abbreviated oral exam. These written and

The University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine Seeks Assistant or Associate Dean Graduate Medical Education

oral components are different then the Part I and Part II components of the primary certification process. They are designed to assess a recertifying diplomat’s cognitive knowledge and practice performance.

Table 1 Certificate

# COLA’s # COLA’s

Exp. Date

attempted passed

2004

0

0

2005

0

0

2006

1

1

2007

2

2

2008

3

3

2009

4

3

2010

5

4

2011

6

5

2012

7

6

2013

8

6

2014

8

6

2015

8

6

See Table 2 on page 22

The University of Medicine and Dentistry of New Jersey – School of Osteopathic medicine is seeking applicants to fill the position of Assistant or Associate Dean for Graduate Medical Education. The Dean has oversight responsibilities for the Office of Graduate medical Education and over 200 residents and interns. The successful candidate must possess advanced degree (D.O., Ph.D., or Ed.D.) and must have experience with the Osteopathic Postdoctoral Training Institution (OPTI). Additional requirements include ability to interface and negotiate with hospital affiliates, solid fiscal management skills and strategic planning experience.

The successful candidate will possess demonstrated leadership experience and a minimum of 5 years significant administrative and educational responsibility. Mail cover letter /CV to R. Michael Gallagher, D.O., Dean, UMDNJ-SOM, 1 Medical Center Drive, Suite 305, Stratford, NJ 08084.

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Table 2 YEAR Core Content Areas Covered 2004 Thoracic / Respiratory Disorders; Immune System Disorders; Musculoskeletal (non-traumatic) Disorders 2005 Nervous System Disorders; Toxicological Disorders 2006 Traumatic Disorders; Cutaneous Disorders 2007 Psycho-behavioral Disorders; Systemic Infectious Disease; Pediatric Disorders; Clinical Pharmacology 2008 Procedures & Skills integral to the practice of EM; Environmental Disorders 2009 Cardiovascular Disorders; Hematological Disorders 2010 Abdominal and Gastrointestinal Disorders; Obstetrics and Disorders of Pregnancy; Administrative Aspects of EM; EMS / Disaster Medicine 2011 HEENT Disorders; Endocrine, Metabolic, and Nutritional Disorders; Renal and Urogenital Disorders Committee Reports Communications – Drew Koch, D.O., FACOEP The Committee discussed the status of the Website and recommended that the College seek input from other vendors to maintain and update the site since the current vendor has not shown sufficient support to the staff or proceeded with immediacy to serve the needs of our College.

The Committee continued discussion of the utilization of the top lectures from the College’s two major CME meetings as potential features in the publication. To this end, the Committee recommended that these lecturers be contacted following the summarization of the evaluations to determine if they would be interested in having abstracts or articles based on their lectures placed in the July issue of the publication.

Also discussed was College’s birthday celebration and suggested that the staff contact the oldest residency program to

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write an article for the July issue of The Pulse on the changes they have seen in their program. Additionally, it was suggested that other residency programs be contacted on a rotating basis to feature 4 – 6 short articles on the programs in various articles to showcase each programs unique qualities.

The Committee did not review its Goals and Objectives but moved that a copy of the document be sent to each member for their input by mid-May. The Committee also forwarded a resolution to the ACOEP Board to support the revision of the Website and to sponsor a Request for Proposal for this to occur during the next fiscal year.

tific Assembly, and COLA Essentials 2. Sub-committee reports a. Administrative Aspects of Emergency Medicine i. Develop a lecture series interspersed with programs (possibly develop a separate program paired with program directors mtg) b. COLA Essentials i. Did very well this year (inc registration and in the black) ii. Next COLA will be in San Diego 2/14/06 – 2/19/06 c. EMS Review i. Intersperse EMS curriculum into Spring Seminar and Scientific Assembly instead of separate tracks Constitution and Bylaws – d. Intense Review John W. Becher, Jr., D.O., FACOEP i. Did very well this year (inc registration) The Committee met its review the first ii. New leadership (Dr. Christensen will stay on as consultant) draft of the new Bylaws. These Bylaws are being formulated to assist in the reincorpo- e. OMM Education ration of the ACOEP in Illinois and have i. Residency standards recommendations been based on the current Constitution made and Bylaws of the College. The Commit- 1. advised to bring these recommendations tee stated that because there are items that to the program directors were removed from the Constitution and ii. CME recommendations to establish a Bylaws that it would work with the various lecture series interspersed into Spring committees, staff and the Board to create Seminar and Scientific Assembly a Policy Manual that would be maintained 1. regular hand’s on sessions also proposed to facilitate the smooth operation of the f. Oral Board Review College as it moves to a more current form i. Updated. Computerized. in its Bylaws. ii. Rejoin / pair with Spring Seminar 2006 Since the Committee spent the major- 1. Change timing to earlier in the week ity of its time on the review and revision (instead of weekend) of the Bylaws, it postponed action on the 2. consider a separate stand-alone course revision of its Goals and Objectives. The in the future as this course continues to Committee further instructed staff to send develop this document to all members and to have g. Scientific Assembly them send their revisions to the Office by i. 2005 in Orlando with the AOA Unity the end of April.

Convention is set 1. all speakers are D.O.’s Continuing Medical Education – 2. one session combined with NeuroPsych Anita Eisenhart, D.O., FACOEP College 1. General topics discussed ii. 2006 in Las Vegas in under construction a. Updated table of organization in h. Spring Seminar accordance with ACOEP i. 2006 is ready to go i. Discussed & amended the Goals & ii. 2007 is under construction Objectives for the Committee iii. Site search under way for 2008 b. Strategies for cost-containment in CME iv. Will decrease duel tracks to one (from two) programs i. Toxicology Review c. Strategies for improving the excellence i. New leadership of speaker selection, topics, venues, and ii. Revisit the idea of a separate course formats every other year d. 5-year plan in development coordinatiii. Continue to intersperse toxicology ing the goals of Spring Seminar, Scienlectures into regular CME

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Membership and Credentials – Murry B. Sturkie, D.O., FACOEP The Committee discussed ideas on how to recruit new members and the retention Geriatric Emergency Medicine (Ad Hoc) of existing members, given the rise in at– Joseph Dougherty, D.O., FACOEP trition during the last fiscal year. Some Committee on Emergency Medical and Kristyna Paradis, D.O. ideas discussed are creating a points system Services – Wayne Jones, D.O., FACOEP The committee outlined its major The Committee reviewed the results of for years of membership; pre taxed salary goals and objectives for the next two years. two surveys submitted by various segments withdrawal for payments for tuition Education was divided into three areas, of the ACOEP membership and decided that and dues. Additionally, the Committee CME lectures and topics, membership and it would not seek to establish a CAQ in this reviewed the application of three members area at this time, but would work with the for Life Membership. Two of these members EMS resource materials.

Liaison relationships were reviewed ACOEP to create educational opportunities qualified for Life Membership, however, one did not meet the criteria and was denied this and a complete list will be submitted to the in this area for the College membership.

The Committee decided to create a status but was advised that he could qualify board for consideration and approval.

Scope of practice for EMS is a docu- lecture series, similar to the series created for Associate member status should he so ment under review by NHTSA and will be by the Undergraduate Committee, that request this status. available for comment at the end of April. would be distributed to the accredited resi- The Committee discussed the goals and The web site is www.emscopeofpractice.org dency programs and interested members on objectives and will review them at the fall In the March issue of USA Today 50% topics pertinent to this area of emergency meeting. of funding for disaster preparedness finds its medicine. This would provide the residency programs with an easy method to incorpo- Pediatric Emergency Medicine (Ad Hoc) way to EMS agencies.

– Anita Eisenhart, D.O., FACOEP CME meeting development will follow rate geriatric emergency medicine into their Over the past few months several the goal/objective template. The commit- curriculum. tee felt the Scientific Seminar might be the The Committee also discussed and surveys have been distributed by the ACOEP endorsed the idea of requesting sponsorship to various groups within the College, with best venue for EMS lectures. : Liz Sibley, Executive Director for Emer- of geriatric emergency medicine through two final surveys to be distributed to the gency Certification Board for EMS (CE- FOEM and perhaps a pharmaceutical remaining College members in the April edition of The Pulse and through the CBEMS) gave a brief presentation about company. residency programs. The first two survey CECBEMS to the committee. results will be used to adapt the pediatric Susan Role a representative from EMSC core curriculum to make it more evidencewas a guest at the EMS committee, and based and more current. To facilitate this project’s successful completion, the Committee developed a timeline for the randview ospital to ost completion of its project so that it will have all ctivities for lumni survey input completed by mid-summer and further projects would be able to be brought t onvention forward for completion at future meetings.

The Committee discussed the potential of changing its status from that of an The Grandview Hospital Foundation is pleased to announce Ad Hoc Committee to that of a Standing that it will be hosting activities for the alumni of its emergency Committee status. medicine residency program at the 2005 Unity Convention in The Committee also recommended that the ACOEP adopt a resolution for the Orlando, Florida. Besides exhibiting, the Foundation will also recognition of the Emergency Medical host a Hospitality Suite on Monday, October 24th from 9:00 a.m.

Services for Children and asked that the to 10:00 p.m. and will host a Reception for alumni on Monday, ACOEP endorse the continued funding of October 24th from 6:00 to 9:00 p.m. this agency by the Federal Government. A copy of this resolution may be obtained on the website.

Alumni from this program should contact Janie L. Ferrell, The Committee also requested that it Development Associate, Grandview Foundation, 937-226-3358 be recognized by the ACOEP Board as a (Phone), 937-226-3610 (Fax) or at janie.ferrell@kmcnetwork.org standing Committee of the ACOEP; this for further information and locations of these events. request was recognized by the Board and this Committee will become a standing j. Special Course i. Difficult Airway course in Washington, DC in September, 2005 and paired with D.O. Day on the Hill

G

updated the members on the voluntary work Dr. Scali has done, and continues to do for EMSC.

H

A A 2005 C

H

A

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committee beginning on October 1, 2005.

Practice Management – Jennifer Wexler, D.O., FACOEP The Committee discussed possible ideas to for practice management policy which include Pre-EMS Diversion, and Overcrowding in the Emergency Department.

The Committee discussed creating a survey to put in the July issue of The Pulse to generate new ideas for practice management policies.

As required the Committee will review its existing statements in the Fall and asked that the membership be requested to submit items of concern to the Committee at this time. A membership mailing of the statements will be sent with the Dues notices in August.

Due to time constraints, the Committee was unable to review its goals and objectives thoroughly and will review them in the Fall.

Research and Awards – Juan Acosta, D.O., FACOEP As requested by the Executive Committee of the ACOEP, the Research Committee reviewed the goals and objectives of the Committee and made revisions it deemed necessary to this document. A revised goals and objectives will be forwarded to the Board for approval later in April.

The Committee discussed the restructuring of the Committee and directed that previous members be contacted to their interest in participating in this Committee.

The Committee wishes to apologize for any misunderstandings generated through the re-structuring process.

The Committee reviewed the competitions and set the deadline for all competitions to be held in Orlando to be July 31, 2005. This will include CPC, Oral Abstracts,

Research Paper, and Poster Competitions.

We will be extending invitations to the College members to participate as judges in these competitions, responsibilities for participating as judges will be forwarded to members in June with the announcement material for the Scientific Seminar, complete with contact information.

The Committee decided to request re-funding of the research awards through the ACOEP at this time, a formal request is being drafted for submission to the Finance Committee in July. The Committee is also making a formal request to the Committee on Undergraduate Medical Education Committee to reinstate student research competition, as three students from around the U.S. participated in our committee and expressed a strong sentiment that research is resurgent among the osteopathic student body. They informed the Committee that research clubs are now being formed on campus.

The Committee reviewed the Poster Competition application and stated that it would be revising this portion of the competitions to include two tracks one for original research and one for case presentation.

At this time the research modules will be tested for technical merit and should be on line in late August if no further glitches are discovered.

Undergraduate Medical Education – James Shuler, D.O., M.S. The Committee welcomed Jeremy Selley, M.S., President of the Student Chapter, who gave a report of the activities of the Student Chapter and its future plans.

The Committee discussed it development of a handbook to assist physicians interested in becoming a mentor to students.

The draft document is estimated to be completed in the fall and following review, will be distributed to all physicians noting

their interests in mentoring students.

The Committee discussed the updating of the Student Lecture Series. Currently, there are about 20 lectures that are in the process of being reviewed, and should have it completed by the Scientific Seminar.

The Committee discussed the Student Case Competition and ways that it can be better advertised to 3rd and 4th year Students.

The Committee reviewed the goals and adjectives and will discuss them further at the Scientific Seminar

Call to Meeting Thomas A. Brabson, D.O., FACOEP, Secretary of the American College of Osteopathic Emergency Physicians invites all members of the College to attend its Membership Meeting on Sunday, October 23, 2005 at the Peabody Hotel in Orlando, Florida.

Reports of Committee and Board activities will be reported and elections for positions on the Board of Directors will be held. Only Active, Activeexempt, Retired and Life Members with paid dues will be allowed to vote for Board positions.

Information on the location of the meeting and candidate biographies will be sent to paid members with their membership cards. Candidate biographies will also be posted on the website after August 1.

Position Available Bay City, Michigan—Opportunity for a BC/BE Emergency Physician at a growing, profitable hospital in Bay City. Busy Level II Emergency department treating over 36,000 patients annually. The hospital has a friendly, cooperative medical staff and coverage for all of the major specialties, including 24-hour catheterization lab availability. Our group offers a stable contract, extremely competitive compensation, flexible and fair scheduling, pension and profit sharing plans. In addition, there is the potential for partnership after two years. If you are interested in learning more about this opportunity, please contact Konnie Licavoli, Physician Recruiter at 800-223-4242, or klmlicavoli@bhsnet.org or check us out on-line at baymed.org

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Presidential Viewpoints Continued from page 3

➢Need to address the working poor ➢Need to include dental care ➢Can’t afford medications so end up in ED ➢Develop consortium of pharmaceuticals to pool resources and offer low cost medicines.

Should ACOEP endorse a single match process? ➢This group discussed the AOA House of Delegates resolution proposed by a large How should mid-level providers be used student organization as well as the AOA in healthcare delivery? opinion. The student body endorses a si- ➢ There was lively discussion among multaneous match. The AOA is opposed. college members from diverse geographAfter considerable discussion, the group ic locations of practice ranging from (which included two residency directors practice environments that use mid-level and two current residents) recommends providers in various capacities form fast ACOEP endorse the current match track to main department sub-acute and system. The general sense was that a critical care. Overall, patient satisfacsimultaneous match could hurt many tion appears to be high when treated by osteopathic EM programs. mid-level providers with and without ➢The group recommended that the issue direct physician supervision. Malpracbe referred to the Program Director’s tice risk and medical legal liability was Subcommittee for further discussion and perceived to be low. Some Pas use a decision from the College. scripted introductions and most give out business cards at the conclusion of Should ACOEP endorse single or dual the visit. residency accreditation? ➢ For maximum billing of Medicare/ ➢The group recommends that ACOEP Medicaid patients, physician must note an endorse single residency accreditation. addition or deletion to the review of The overwhelming opinion was that systems in the chart. residents graduating form the three ➢ Some PA’s are doing intubations and dually accredited programs opt to take central line placements. only the ABEM exam and do not choose to ➢ The majority of PA’s work fast track. become ACOEP and AOA members. ➢ Three levels of PA responsibility are designated by some ED’s depending What relationships should ACOEP puron training and experience ranging sue with other organizations/agencies? from fast-track encounters that are not ➢ACEP discussed with physicians to presentation ➢AAEM of cases to the ED physicians by the PA ➢SAEM similar to residents. ➢PA’s ➢ Weekly didactic sessions are conducted ➢NP’s (many work with NP’s and state for PA’s in some departments.

NPs feel unsupported) ➢ There appears to be an increasing use of ➢Military connections mid-level providers in hospital EDs. ➢European emergency providers ➢ Some College members perceive ➢Homeland security mid-level providers as a threat to their ➢It was suggested to create a council of job security and will not use them in their all professional organizations that are departments. involved with the practice of emergency medicine The Committees and the Board would like to hear from those that could not participate How can ACOEP engage our society to in these round tables. We would also like affect the healthcare crisis? to hear form those that did attend. What ➢The way society views EM, i.e., free, just did you think of the process? To all, what a clinic, needs to be changed are other questions we should consider if we ➢Present proposals don’t address real life use this format in the future? Talk to each issues of access to healthcare so people other about these issues in your departments. go to the ED (access 9-5, medical/legal Engage! We look forward to engaging adverse to phone advise) with you. ➢All kids must be covered for healthcare ➢Immigrants should have coverage

The PULSE JULY 2005

Continuing Medical Education Calendar 2005-2006 August 12 –14

Sequencing – The Art of Finding The Key Holiday Inn Select North at the Pyramids, Indianapolis, IN 20 hours Category 1A Contact: Indiana Academy of Osteopathy 317-926-3009

September 15-16 Oral Board Review

Sheraton Suites Alexandria,

Alexandria, VA

10 hours Category 1A 17-18

Difficult Airway Course Sheraton Suites Alexandria, Alexandria, VA 5 hours Category 1A

October 23-27

AOA Unity Convention ACOEP Scientific Seminar Orange County Convention Center, Orlando, FL 25 Category 1A

November 15-17 HazMat Expo9

Orleans Hotel & Casino, Las

Vegas, NV

For Information

Call 702-455-5710 2006 January 5-9

Emergency Medicine: An Intense Review Westin Hotel River North, Chicago, IL 40-42 hours Category 1- 1A

February 12-14 Program Directors Workshop

Hilton LaJolla Torrey Pines

Resort, San Diego, CA

10 hours Category 1A 14-18

Core Essentials Hilton LaJolla Torrey Pines Resort, San Diego, CA 25 hours Category 1 – 1A

April 18-22

ACOEP Spring Seminar Wigwam Resort & Golf Club, Litchfield Park, AZ 25 hours Category 1 – 1A

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ACOEP Welcomes New Fellows At its meeting in March, the ACOEP granted the honorary title of Fellow of the American College of Osteopathic Emergency Physicians (FACOEP) to the following members: Robert Adams, D.O., Bloomington, Indiana; Rohit Agrawal, D.O., Pittsburgh, Pennsylvania; Gregory J. Beirne, D.O., Wildwood, Missouri; Brad Blaker, D.O., Goodrich, Michigan; Jeffrey Butler, D.O., Glendale, Arizona; Barbara Celestina, D.O., Scottsdale, Arizona; Mario Cosenza, D.O., Randolph, New Jersey; Gregory Fuller, D.O., Jackson, Michigan; Cynthia Gessler, D.O., Malvern, Pennsylvania; Keischa Glenn, D.O., Columbia, Maryland; Alan Goodrich, D.O., Medina, Ohio; Brett Greenfield, D.O., Voorhees, New Jersey; Todd Hartgerink, D.O., Byron Center, Michigan; Daniel Hearld, D.O.,Ada, Michigan; David Kraus, D.O., Farmington Hills, Michigan; Jay Kugler, D.O., Ashburn, Virginia; James Lambros, D.O., Ashtabula, Ohio; Nicole Lang, D.O., Aventura, Florida; Khoa Luong, D.O., Oakland, Michigan; Steven Mifsud, D.O., York, Pennsylvania; Monte Mitchell, D.O., Ocean Springs, Mississippi; Terrence Mulligan, D.O., Washington, D.C., David Neckritz, D.O., Monroe Township, New Jersey; Christopher Nichols, D.O., Waterford, Michigan; Daniel Oberdick, D.O., York, Pennsylvania; Price Paul Omondi, D.O., Champaign, Illinois, Ernest Patti, D.O., Bronx, New York; Kevin Roth, D.O., Kansas City, Missouri; Thomas Seglio, D.O.; Ocean Springs, Mississippi; Edith Szabo, D.O., Elmwood Park, New Jersey; Jeffrey Umfleet, D.O., Cape Girardeau, Missouri; Tam VanVoorst, D.O., Dubuque, Iowa, Stacy Williams, D.O., Glendale, Arizona, and Thomas Zuesi, D.O., Galena, Ohio.

The Fellowship Ceremony will be held at the AOA Unity Convention / ACOEP Scientific Seminar on Monday, October 24, 2005 at the Peabody Hotel in Orlando, Florida. The Ceremony will begin at 6:00 p.m. with the recognition and granting of awards followed by the Fellowship Ceremony. Members, Fellows and their families are invited to celebrate ACOEP’s 30th Birthday at the Members Reception immediately following the culmination of the Fellowship Ceremony.

Please watch our website for the location and times of these events.

Ethics in Emergency Medicine Bernard Heilicser, D.O., FACOEP

What Would You Do? Our patient is a 32 year-old female who presented to the ED requesting drug detoxification and treatment for hypertension. She stated she had a four-year history of Vicodin and Tylenol #3 abuse resulting from migraine headaches and lupus. On further history, the patient stated she was getting the drugs from her husband. Rather disconcerting was the fact that her husband was employed as a Tech at another hospital.

• • • • •

Besides treating the patient, should ay further action be taken?

Should the husband be reported?, and, how?

Should the husband be directly confronted? The patient did not want this to happen stating confidentiality issues.

Should we ignore the connection and just treat the patient?

What would you do?

Please send your thought and ideas (fax 708-915-2743). Every attempt will be made to publish them when we review this case in the next Pulse.

If you have any cases in your practice that you would like to present or have reviewed in The Pulse, please Fax them to us.

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The PULSE JULY 2005

PHCS-05-465_The Pulse

6/14/05

Nathaniel Sherman, MD Chairman, PHCS Diversity Committee PHCS physician since 1991

11:20 AM

Page 1

Doug Finefrock, DO Candidate for PHCS Leadership Program PHCS physician since 2003

Joan Kolodzik, MD PHCS Director of Education Past PHCS Board Chair PHCS physician since 1989

Steve Yamaguchi, MD ED Medical Director Mercy Hospital-Fairfield PHCS physician since 1998

It’s Your Career.

Shouldn’t It Feel Like It?

DO YOU SEE YOURSELF IN THIS PICTURE?

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At Premier Health Care Services, our goal is to provide you with a rewarding career as an emergency physician.

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VISIT US AT ACEP BOOTH #711 The PULSE JULY 2005 NOTE: Images are hires ready. Trim: 8.5" x 11" Live: 7" x 10" Non-Bleed B/W

_The Pulse - July

27

ACOEP NEWSLETTER

Presorted Standard U.S. Postage

PAID

Chicago, IL Permit No. 2177

142 E. Ontario Street, Suite 1250 Chicago, Illinios 60611

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The PULSE JULY 2005