Sharonda Brown, BSN, RN: Stressing Communication in the Emergency Department

In the second of a 3-part interview with MD Magazine, Sharonda Brown, BSN, RN, a senior emergency department consultant with American Academic Health System, at Hahnemann University Hospital, discussed the overall importance of communication—between not just providers, but patients as well—in making sure the emergency department runs efficiently.

Brown also spoke about the necessity of focusing on efficiency without sacrificing quality in an environment such as the emergency department, where so often time is of the essence. Additionally, she noted how Hahnemann has taken advantage of the use of physician extenders, such as nurse practitioners, to keep the triage process from becoming encumbering.

Watch the previous installment, Part 1 of the interview, here.

Watch the next installment, Part 3 of the interview, here.

MD Magazine: How do you keep the focus on quality while trying to improve the speed at which patients get to the providers? Are you sacrificing one for the other at times?

Sharonda Brown, BSN, RN, a senior emergency department consultant with American Academic Health System:

We don't want to compromise quality in patient safety for efficiency. So, it's very important, again, that we complete an accurate assessment and know every step that the physician and nurses are taking, by again, removing those non-value-added steps—those duplications.

Communication, communication, communication, is key. In real estate, they say location, location, location. In our environment it is communication—the physicians in each discipline must communicate in each step of the process. We also have to include the patient, so we can decrease the patient's anxiety.

Our patient satisfaction scores are key, and since we've been here, our patient satisfaction scores have increased drastically, from 51.9% to 86.9%. I think that's a huge win. What that means for us is that the patients are responding to the process changes. They do feel the change. They do feel that they're being treated immediately, and that's key, right?

Remember, time is of the essence. Time is tissue. Time is muscle. What does that mean? We have patients coming in having a heart attack, STEMI, strokes, sepsis. Time is everything when taking care of those patients. If we don't jump on them in a timely manner, then we have poor outcomes. Efficiency is definitely a priority, but it's still important to note that without compromising our quality.

We do have a national shortage of nurses and physicians, and so physician extenders are key in this case. Remember, most of our patients are coming to the hospital to see a physician and so how can we better support the physicians? You use physician extenders. You use nurse practitioners, you use physician assistants. In our model, we're using nurse practitioners. That lends a helping hand to those least urgent patients.

We have 5 levels of triage that we use here. Number 1, we're basically resuscitating you—you need to see a physician. Number 2, if we don't do something, those STEMI patients, those stroke patients, those septic patients, you will be resuscitating them—you need to see a physician.

Number 3 is key. Those are our longest length of stay patients. They come in with chest pain, abdominal pain. We have to rule out cardiac arrest, we have to rule out where this patient is having a heart attack or not, and then with your abdominal pain patients, come multiple diagnostic tests. So how can we process those patients? That’s back to those vertical threes—those patients that do not require bed, that we can treat in a nice recliner while we're running their diagnostic tests. That frees up the capacity of the emergency department, it increases the capacity of the emergency department, allowing us to see more critical patients in those beds and give those patients that dedicated time at the bedside.

Transcript edited for clarity .