Team-based approach in ED stabilizes metrics, catches an i

With a shift in leadership and what he calls some “small changes,” Ryan Paterson, MD, medical director in the Emergency Department since last summer, proves you can achieve more – and better – with less.

Even as daily physician coverage has reduced by nearly half, the department continues to provide expert care to the same volume of patients with no drop in acuity, and EMS crews continue to seek out Saint Joseph as the city’s Emergency Department of choice.

“There was some grumbling in the department initially, which I understand; we dropped from 72 hours of physician coverage in the ED per day to just 45, which doubled our physicians’ patients-per-hour seen, from about 1.5 to 3 on a busy day,” Paterson said.

“I pushed us toward a team-based attitude and approach to care, and everyone jumped in. Our physicians, APPs, nursing, EMTs and everyone chose to support each other in our collective effort to provide the safest, best-possible care, and the bumps in the road quickly started to smooth out.”

Silver lining: The reduction in staff revealed inefficiencies that have been addressed. Patient triage has been streamlined, and partnerships with nursing and EMS have strengthened and expanded.

Volumes remain steady. Ambulances arrive at the same rate. There was an initial bump in left-without-being-seen cases, but that has since returned to normal. Seventy-two-hour returns are stable, a strong indicator of highly accurate triage and diagnosis.

This early success has attracted attention. The Saint Joseph Emergency Department is the first Peaks department to receive Intermountain Health’s You Caught Our i Award – in this case, for strengthening the department’s culture and improving teamwork.

It also seems to indicate Paterson, with advanced training in the joys and challenges of ‘more-with-less medicine,’ is the right leader at the right time.

Paterson attended the University of Vermont School of Medicine in Burlington and completed both his Emergency Medicine residency and his fellowship in Wilderness/Altitude/Expedition Medicine at Denver Health/CU Denver. He also holds advanced certifications in Mountain Medicine and in Tropical Medicine from the London School of Tropical Medicine and Hygiene.

This unique specialization has propelled Paterson around the world to provide care and medical training in some of the most remote and unlikely places.

Paterson conducts Mountain Emergency Medicine courses around the world. At left, he’s in the Cordillera Blanca Mountain Range in Peru. He’s also in Peru at center conducting a course he leads yearly. And at right, he’s in Canada.

Below, in the first image, that’s Paterson hanging from a heli during long-line rescue training. In the center, he’s rescue training at 17,000 feet in Peru. And at right, he’s engaging in a climbing rescue in North Patagonia.

“I’ve been to deserts, jungles and the north side of Everest,” said Paterson. “Walls, lights and access to specialists are great, but I love the improvisation and challenge of backpack medicine. The crazier the place, the more fun it is.”

Well, it’s about to get crazier. Paterson takes off in April to provide trailside care for an ultramarathon across Uzbekistan. The GlobalLimits Uzbekistan - Footsteps of Alexander the Great is an all-trail event that calls for runners to traverse a craggily 230 km (143 miles) in six days, through the heart of the ancient Silk Road.

Typically, days in Uzbekistan at the end of April are pleasant, with temperatures in the mid-to-high 60s. A former professional triathlete himself, Paterson expects to treat runners’ injuries, such as falls and sprains, and wilderness injuries, such as infections.

Below at left, Paterson is race doctoring an ultramarathon in Bhutan, on the eastern edge of the Himalayas. In the center, he’s ultrasounding a patient in Iraq in 2017. And at right, he’s providing foot care to an untramarathoner in São Tomé, Africa.

As exciting as this work can be, Paterson’s true passion is at home. He and his wife, Amy, a kindergarten teacher whom he calls “a saint,” have two teenage daughters, Harper and Clara.

Colleagues with questions about care in the Emergency Department or those who want to wish Paterson well on his next medical expedition can reach out to him at ryan.paterson@imail2.org.