Check the “Educational Conferences” page for more information (hotel, etc).

Hope to see you there!  Lindsey

Lisa Dixon, MD

Wanda Binns, MSW, Manager, University of Maryland, reviewed how an effective EAP provides a front line defense against violence in the workplace and is a key component to providing a healthy work environment for both patients and employees. When policies are written and communicated they provide both strength and boundaries for professional staff and help to reduce the possibility of potential conflict. Without policies we are not setting the standard of professional behavior and invite opportunities for employees to set their own level of expected behavior. The use of EAPs is one of the best tools to transition employees thru difficult issues both in their personal lives and in the challenges of work.

George Economas BS, Director of Internal Security, Johns Hopkins Institution, reviewed how the security officers in their institution responded to a very unfortunate crisis with a patient who killed both his parents and himself one fateful afternoon. Mr. Economas was very clear that the major lesson they learned was the importance of immediate communication with the public, the government, and the hospital employees to ensure the safety of all concerned and to help reduce the high level of anxiety that will explode with such a terrible event. Subsequent developments have included again the writing of safety policies and the proper training of staff to strengthen the bonds of trust between the professional staff and the community at large.

(Article by by Dan Hogge. Dan is the administrator of the University of Utah Department of Psychiatry.)

The new training changes fall into two categories, duty hour limitations and rules on supervision and are effective on July 1, 2011. The purpose of residency training is to give residents optimal opportunity for training in a safe environment.

The new duty rules recognize the dangers associated with sleep deprivation on both the resident and on patient care. Intermediate level residents must have eight hours between their scheduled duty periods and can only work 16 hours straight. They must have 14 duty hours free following 24 hours of inhouse duty. Because residents in the final years of their education have to be prepared to practice medicine and care for patients over irregular or extended periods of time, their rules are less strict. While it is still desirable to have eight hours of duty free time between scheduled duty periods, there may be circumstances when this is not possible. They can work 24 hours straight but can work an additional six hours wrapping up the work. Working six hours in an outpatient area after a 24 hour shift is not allowable. Residents may not be scheduled for more than six consecutive nights of night float.

The new supervision rules are intended to assure that adequate supervision is available to residents as their training progresses. At the beginning of training the entire interaction needs to be supervised directly. Once the trainee is able to recognize when help is needed, can ask for help, can demonstrate an ability to perform an intake, can complete a history and physical assessment, can deal with safety concerns and present cases clearly, the trainee can be advanced to the indirect level. Indirect supervision allows for the trainee to treat a patient as long as direct supervision is immediately available. The resident might treat the patient and report later about what was done. Residents must care for patients in an environment that gives them the opportunity to work as a member of a multidisciplinary team.

These changes present a challenge to all academic institutions. Who will backfill and provide the level of care? What will be the cost? In Maryland, attendings and nurse practitioners will perform the services that were done by residents in the past. Patients will be seen by two clinicians instead of one. Will these new rules allow for adequate training? Will they have enough experience? There is a significant financial consequence to the changes in resident training. It is an unfunded mandate that is estimated to cost the University of Maryland $3.5M per year. Some fear that further reductions in duty hours might follow.

The impact on staff is significant. The attendings are working longer hours (60-80 hours) without additional compensation, their workload has changed significantly. During this same period they have had to adapt to the electronic medical record. Currently each clinical faculty supervises one or more trainees. Community physicians train residents too. The University of Maryland is considering giving incentives for teaching.

The demand for nurse practitioners continues to grow. Their skill set and salary makes them an attractive alternative to physicians. The time to train a nurse practitioner to work in Psychiatry is significant and they often transfer to another department.

Patients will have a greater number of caregivers as a result of the new rules. There was some discussion about the need for additional communication and increased hand-off of care. The panel participants agreed that there can be a lack of continuity and they have developed formal sign-outs to deal with this.

They estimate that it will take ten years to see the impact of this change.

(Article by Deb Tatchin. Deb is Finance Manager of the U Michigan Department of Psychiatry).

Ms Preiss Lunken outlined the “Rules of Engagement” to consider when developing a successful philanthropy program. Among the many critical factors described is the importance of the physician-patient relationship and understanding where the patient is in the course of their disease. Physicians need to be aware of patients that may have means and an interest in giving. Learning to be aware of the questions that patients or their families ask is important to the development process. Grateful patients may be interested in giving if they have had a good experience or successful treatment but Ms. Preiss Lunken reminded us that some patients and families are motivated to give if they have not had the best outcome and are looking to use the opportunity to help others. In addition to being able to identify potential donors, it is just as important to understand what a department has to offer a potential donor in order to match programs needing funding to donors with an interest in those programs or diseases.

In an effort to continue to develop a philanthropicallyminded culture, Hopkins has used videos and posters to remind both patients and staff of giving opportunities. Many times, staff may be the first to hear patients express interest in giving.

Ms. Priess Lunken also highlighted the importance of taking a long-term approach towards development and the stewardship of donations. Building trust and rapport with potential donors is paramount as is ongoing involvement of Department and University leadership. As more donations are being directed toward specific projects, the Hopkins development team provides donors with details on outcomes from the research or programs that their donations support. In addition to sending annual reports, the Hopkins Development team will often visit donors yearly and schedule periodic communication.

(Article by Shiyoko Cothrin. Shiyoko is the Operations Director of the Penn State U Department of Psychiatry).

The prior regulations required a hospital’s governing body to appoint all practitioners to its hospital medical staff and to grant privileges using the recommendations of its medical staff. In turn, the hospital medical staff used a credentialing and privileging process, provided for in CMS regulations, to make its recommendations. CMS requirements do not take into account those practitioners providing only telemedicine services to patients. Consequently, hospitals applied the credentialing and privileging requirements as if all practitioners were onsite. This traditional and limited approach failed to embrace new methods and technologies for service delivery that might improve patient access to high quality care.

CMS came to the conclusion that this previous requirement was a duplicative and burdensome process for physicians, practitioners, and the hospitals involved in this process, particularly small hospitals and CAHs, which often lack adequate resources to fully carry out the traditional credentialing and privileging process for all of the physicians and practitioners that may be available to provide telemedicine services. In addition to the costs involved, small hospitals and CAHs often do not have in-house medical staff with the clinical expertise to adequately evaluate and privilege the wide range of specialty physicians that larger hospitals can provide through telemedicine services.

Essentially, the new provisions will allow for the governing body of the hospital (or the CAH’s governing body or responsible individual) to rely upon the credentialing and privileging decisions made by the distant-site telemedicine entity when making its own decisions on privileges for the individual distant-site physicians and practitioners providing such services, if the hospital’s governing body (or the CAH’s governing body or responsible individual) ensures, through its written agreement with the distant-site telemedicine entity, that the distant-site telemedicine entity’s medical staff credentialing and privileging processes and standards meet or exceed CMS standards.

The removal of unnecessary barriers to the use of telemedicine may enable patients to receive medically necessary interventions in a timelier manner. It may enhance patient follow-up in the management of chronic disease conditions. These revisions will provide more flexibility to small hospitals and CAHs in rural areas and regions with a limited supply of primary care and specialized providers. In certain instances, telemedicine may be a cost-effective alternative to traditional service delivery approaches and, most importantly, may improve patient outcomes and satisfaction.