Azmat Husain, MD: The Emergency Department as a Primary Access Point of Care

In Part 1 of a 4-part interview with MD Magazine, Azmat Husain, MD, the senior vice president of clinical operations and chief medical officer of American Academic Health System, at Hahnemann University Hospital, discussed the emergency department as a whole at the hospital, which recently underwent drastic changes that have resulted in improved satisfaction and outcomes across the board.

Husain spoke about his love for emergency medicine, and how the American Academic Health System and Hahnemann have tempered their approach to it to focus on the providing for the needs of the patients, emphasizing the department's role as a primary access point of care. He also spoke about the methods that the staff utilized to revamp their emergency department process—including a focus on communication and involvement—to improve door-to-doctor times, decrease the length of stay, and increase both provider and patient satisfaction.

Watch the next installment, Part 2 of the interview, here.

MD Magazine: What goes into making the emergency department run so smoothly? What needs to be done and what resources need to be utilized?

Azmat Husain, MD, senior vice president of clinical operations and chief medical officer, American Academic Health System:

Being, obviously, equipped with the ancillary support services from the social work and case management—but it's more than that, right? I mean, it's really every nurse, every physician, every nurse practitioner, every housekeeper, every tech, understanding the dynamics and the challenges that this patient population has.

I always find emergency medicine to be an amazing field because as a field of practice, it's the one area where, when society perceives they have are nowhere else to go, they come to the emergency department. Whether they do or not, when they perceive they have nowhere else to go, they come to someone like me. I'm given that responsibility to dig them out of their worst spot, and I think each one of our providers—everybody who encounters a patient in the emergency department—if they're able to understand that, then they're able to provide a level of care that is commensurate with what's needed at the time.

It's interesting that a lot of times in the emergency department, a big thing that gets talked about in the political arena is, “Well we have all these unnecessary emergency department visits.” I tend to have a different take on that because I think it's the patient that determines what's necessary at that time, and the patient, at that time, whether they're having abdominal discomfort or they're having whatever else is going on their life, they feel at that point that they need attention now. It's not my, or any physician’s or any public health official’s, job to be able to say that, “Well, that wasn't appropriate for you to come to here.”

I think we need to be providing other avenues as well to have more access in communities, but really, in an inner city—in a downtown, urban environment—the emergency department is one of the primary access points of care. Understanding that, understanding the needs of those patients, is vital.

Any process in the world that you try to implement, especially in the emergency department, it's all based on buy-in and flexibility, right? Can you tailor make a process to your department? Here, myself and Sharonda [Brown, BSN, RN]— I was the chairman of the emergency department and she was the nursing director at Howard University in DC, and we went through the same process. Really, what it is, is that you get your buy-in before you implement a process. Really understanding the needs and understanding the challenges that the department is facing and addressing those first.

We always say—and 1 of our nurses here really brought it up, and it's stuck with me—that accountability is a 2-way street. Meaning, oftentimes as an administration, you try to hold the staff accountable, but a staff also has the right to hold you accountable first.

As we implement process changes, the first thing was that we were going to allow the staff to hold us accountable first. What is it that you need to provide your basic care that is not being provided right now? Let us deliver that first, and then we'll turn around to you and say, “Okay, now let's implement a new process.”

The second thing is the build-out of a process, and that was a lot of fun here. That process was like a month-long process of intensive meetings, and it was it really was a lot of fun to have representation from the physicians, the nurses, the housekeepers, the IT staff, the techs, all in 1 room, split up into 2 groups. We had the had the whiteboards up and we just laid out the principles. We laid out some principles in regard to a few things. When a patient comes in and they want to see a provider as soon as possible, how do we get a provider up front to them as soon as we can? How do we increase capacity in the back? How do we manage our flow internally? We laid our principles, and it was remarkable to see how the team came up with pretty much a process that aligned with what we had thought initially, but with some amazing pearls. So really, for process implementation and for buying-in and for success, that build-out process being done together was so key.

Transcript edited for clarity.