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Skilled emergency physicians at Calais hospital are involved in the community

Dr. Guy Nuki is the regional medical director for the Brunswick-based BlueWater Emergency Partners, which recently contracted with Calais Regional Hospital to staff the hospital’s Emergency Department with skilled emergency physicians.
Brian Swartz
Dr. Guy Nuki is the regional medical director for the Brunswick-based BlueWater Emergency Partners, which recently contracted with Calais Regional Hospital to staff the hospital’s Emergency Department with skilled emergency physicians. Buy Photo
Posted May 11, 2012, at 3:11 p.m.
Whitney Hayward, RN, enters a patient's information into an Emergency Department computer Calais Regional Hospital. (BDN Photo by Brian Swartz)
Whitney Hayward, RN, enters a patient's information into an Emergency Department computer Calais Regional Hospital. (BDN Photo by Brian Swartz) Buy Photo

CALAIS — A partnership between Calais Regional Hospital and BlueWater Emergency Partners has paid extensive dividends for patients visiting the hospital’s Emergency Department.

Last year, the hospital and BlueWater established a partnership to staff the CRH Emergency Department with skilled emergency physicians. “BlueWater committed to joining the CRH family in its efforts to promote the Emergency Department’s continued growth and development,” said CRH Chief Executive Officer Michael Lally.

“Their commitment and understanding of our quality measurements was a great strength,” he said.

The Brunswick-based BlueWater Emergency Partners staffs emergency departments at CRH and at Mid Coast Hospital in Brunswick. “We’re a private group of emergency physicians,” said Dr. Guy Nuki, MD, the BlueWater regional medical director. “We bring quality emergency-department staffing and quality emergency-department management to hospitals in Maine.”

The company’s physicians are residency-trained and board-certified in emergency medicine or are board-certified in primary care and have at least five years’ full-time experience in emergency medicine. According to Nuki, the BlueWater staff includes eight physician partners, three full-time physicians, and several physician assistants and nurse practitioners. The physicians forming the core providers for the CRH Emergency Department are Nuki and:

• Michael Bell, M.D.;

• Cressey Brazier, M.D.;

• Walter Doerfler, M.D., the Emergency Department medical director.

These four physicians will staff the Emergency Department 28 days a month; other BlueWater physicians will staff the CRH Emergency Department the remaining days. No matter who is on duty, patients will be seen by an emergency physician or an advanced practice provider fully dedicated to patient care.

“The Emergency Department is more than just its four walls,” Nuki explained. “For our physicians, it’s not just their education and credentials: Their approach to their jobs and careers is based on knowing they’re part of a team that’s centered around the patient.”

According to CRH Chief Nursing Officer Cheryl Zwingman-Bagley, RN, “when we worked with the previous company” that staffed the Emergency Department, “we had a number of physicians … who were irregularly scheduled” and did not have “that commitment to the Calais Regional Emergency Department as an entity.

“We knew that wasn’t what we wanted for our patients,” she said.

“Emergency physicians have to take into account not only what happens in the hospital, but in the community,” Nuki said. “Health care is not just when you get sick.” He cited “wearing a seat belt” or donning “a bike helmet” as steps that people can take to “care for themselves.”

“We will be involved in the community,” with BlueWater emergency physicians speaking at “health education classes held locally” and “working with local Emergency Medical Services teams,” he said.

Other positive changes are occurring in the CRH Emergency Department. When Mark Nischwitz was the department’s interim nurse director last spring and summer, he and hospital personnel held multiple meetings to improve and streamline patient care in the Emergency Department.

“We knew that we needed to do things differently,” Zwingman-Bagley said.

A multidisciplinary team drawn from the Emergency Department, Inpatient Care, the Laboratory, Radiology, and Registration recommended specific steps to reduce the time needed to treat a patient. “Bedside [patient] registration was an important change,” Nuki said.

“The goal is to get the patient to see a medical provider as soon as possible,” he said. The Emergency Department has significantly reduced its “door-to-doc” time from 60 minutes last June to 20 minutes in December. This means that a patient entering the Emergency Department will typically be seen by a medical provider in 20 minutes.

“People come to the Emergency Department to see a [medical] provider,” Nuki said. “The shorter the time it takes to do that is better care.

“These times are very good,” he said. “The national standard is 30 minutes for door-to-doc time.”

For a stroke patient, the average time from arrival at CRH to having a CT scan is now 10 minutes, 60 percent sooner than the nationally recommended 25 minutes. “This is an excellent time,” Zwingman-Bagley said.

Another positive change has involved creating standardized patient treatment plans. In the past, Emergency Department physicians often prescribed different treatment plans for patients suffering from similar ailments, according to Zwingman-Bagley. “We felt disjointed; we had to adapt to each doctor’s prescription. They weren’t standardized,” she said.

In the past several months, the CRH Emergency Department has standardized its patient treatment care. “We’re setting up guidelines and protocols for different medical issues,” including heart attack, pneumonia, sepsis, and stroke, Nuki said.

With such guidelines in place, “we provide consistency in evidence-based quality care,” he said.

Explaining the standardized patient care in a layman’s terms, Nuki said that “emergency medicine is a team sport” that requires “a playbook with specific guidelines” for all hospital departments and personnel involved in emergency medical care. No doubt exists as to how a patient with a specific medical condition will be treated; the published guidelines and protocols are located in the Emergency Department and elsewhere in the hospital, and CRH staffers adhere to them.

“Everybody knows the timelines” for patient care, Zwingman-Bagley said.

Physicians from BlueWater Emergency Partners trained CRH staff in the new guidelines and protocols. “I’ve been amazed at coming to this hospital and seeing such a strong desire among the staff for quality improvements,” Nuki said.

With guidelines and protocols in place, “we can start our [patient-care] system when EMS picks up the patient” for transportation to Calais Regional Hospital, Nuki pointed out. By the time the patient arrives at the Emergency Department, the hospital staff “is ready to start treating the patient immediately,” he said.

Another positive change has involved Emergency Department staffing. Past experience indicates that certain days — Mondays, for example — and certain times of day — 10 a.m. to 10 p.m. — are the busiest periods “in the ED,” Zwingman-Bagley said. “We have added coverage to meet the increased demand.”

A BlueWater Emergency Partners physician is on duty 24 hours a day. To support the doctor and respond to higher demand for Emergency Department services, Calais Regional Hospital has created additional shifts and staffed these with nurses trained in emergency care.

All the changes made recently in the Emergency Department are noticeable inside and outside Calais Regional Hospital. “We’re all a lot happier now,” Zwingman-Bagley said. “Internally our work environment is a lot more positive … there is a lot of dialoging and discussion going on.”

“We’ve had several stories of people in the community commenting on the changes they’ve noticed and how much they like it,” Nuki said.

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