Top doctor at Finger Lakes Health talks about why his hospitals have some of the shortest ER wait times in the state and why he thinks AI will help free up time for physicians to spend more time with patients
By Chris Motola
Q: You’ve been chief medical officer of UR Medicine Finger Lakes Health for a year now. What was that first year like?
A: I love challenges. I’m an ER physician by training and came out to Finger Lakes Health in 2008. And during that first decade or so, I worked clinically and got involved in leadership. I took over the ED [emergency department] leadership in 2016. So my mentors here, the previous medical director Jason Feinberg and our CEO Dr. Acevedo really knew the importance of having a succession plan. So my year prior to becoming CMO [chief medical officer] I was an associate CMO. A lot of the quality initiatives that we’ve done in the emergency department with the Joint Commission as a primary stroke center, as a chest pain center of excellence, there was a lot of natural growth there for me as I took on different duties other than emergency medicine. So my leadership here has evolved through the emergency department as director and now more in a system-wide role. So that’s really given me great energy to improve and continue the successes that we’ve had and different disease processes like stroke and chest pain and things like that.
Q: Geneva General Hospital and Soldiers and Sailors Memorial Hospital have two of the shortest ER wait times in the state. How did you pull that off?
A: That’s something that we’re very proud of. We’ve had the shortest door-to-doc times for the last 10 years or so and CMS data at both hospitals has also shown that. It’s really a culture of not accepting patients staying in the waiting room for long periods of time. What we do is called “pull to full,” so we pull those patients back into the actual, physical space in the emergency department. Of course, different hospitals have different challenges. We don’t see 120,000 patients a year with the constraints of, say, a Strong Memorial Hospital. They use different types of solutions, like having a physician in triage to at least get the care of those patients going. On the other hand, we often only have one physician staffing our emergency department. It’s really about working collaboratively with nursing and ED nursing leadership. It’s a cultural idea that we’re not going to leave a patient in the waiting room. In the end, it’s also better for the staff. I’ve seen the satisfaction. When you promote throughout it’s very satisfying.
Q: How about the rest of the process? Have you improved treatment times as well?
A: It’s not just the door-to-doc times that we’ve had a lot of success on, but also if you look at recent national and regional data, we have some of the best treat-to-release times too. So that’s the time between when you’re seen and when you’re discharged. The efficiencies we’ve been able to adopt through the lab, through radiology are really interdisciplinary. Patients have so many choices now. When I started in 2008, there were no urgent cares in the area. Now we have one in Seneca Falls, in Geneva. So people are going to pick where they know they’re going to have quality, but also where it’s a more efficient use of their time.
Q: What advantages does coming from an emergency medicine background have when you reach a system-wide administrative role?
A: I think one of them is that we are a specialty that really has to be able to effectively communicate with all types of sub-specialty services, whether it’s working with the hospitalist team to transfer someone from the ED to the inpatient side or consulting with surgical teams. When you’re working with different specialties there can be disagreements, so being that person at the bedside of the patient you’re really able to drive what the patient needs. Those communication skills have really served me as I’ve transitioned to an administrative role here as well as in our collaboration with UR Medicine. We have a lot of those synergies where I think working across different service lines across the medical spectrum helps in a lot of ways.
Q: What are some of the challenges you see coming down the pipeline?
A: Every day we have more and more regulation. The human resources required to keep up with those regulations is significant. We want to deliver the highest quality care that we can, but physicians are often constrained with the electronic medical record and the time that it takes to complete and get through those documentation requirements. I think AI is going to play a big role in the next five to 10 years and take some of that burden off the physicians and allow them to be back at the bedside more. Also, as we’ve come out of COVID a significant amount of our nursing staff is contracted through outside agencies. So there’s more turnover there than there used to be. So a lot of our initiatives have been focused on getting nurses to come back in-house. It helps to improve quality and standardize and streamline processes. So I think things to watch in the next decade will be how much AI can lessen the burden on providers on the documentation end, and how can we incentivize nurses to come back to the bedside as employees.
Q: Why did that contractor model become so popular?
A: There’s no single answer. As I’m sure you’re aware with COVID, a lot of things became remote. People, because they were staying at home, weren’t getting as ill, having as much trauma. Volumes went down at the ER. But you also had places that had very sick patients with COVID that affected the mental health of medical community. A lot of nurses retired or took remote jobs doing non-patient-facing activities. To be honest I think a lot of the agency nurses did enjoy that flexibility of having more control over their own work environment and lives. I think COVID did accelerate some of those trends.
Q: How do you get them back?
A: I think we have to be a welcoming work environment and make sure the nurses have what they need to do their job. We have a nursing leadership team that supports all of those things. We had much lower nursing turnover rates in the last 18 months. We’ve also had some success bringing back nurses who had left for other hospitals or contractors. We’re trying to make sure they have a say in their own environment and a clinical ladders program that encourages growth. And I think we’ll have more success as we grow those initiatives.
Lifelines
Name: Matthew C. Talbott, M.D.
Position: Vice president, medical affairs & chief medical officer at UR Medicine Finger Lakes Health
Hometown: Springfield, Ohio
Affiliations: UR Medicine Finger Lakes Health (Geneva General Hospital, Soldiers and Sailors Memorial Hospital
Organizations: American College of Emergency Physicians; American Board of Emergency Medicine
Family: Wife (Shelley), son, three daughters
Hobbies: Basketball, golf, outdoor activities, travel