Martha's Vineyard Hospital adds physician assistants
Photo by Ralph Stewart
John McElhinney looked more embarrassed than pained, a big strong 27-year-old guy lying there in a bed in Martha's Vineyard Hospital's emergency department.
Physician assistant (PA) Anthony Piland stood bedside, wrapping a super size gauze pad around the Chappaquiddick resident's finger, which had caught a huge splinter while he was working with his father, who owns a painting and restoration company.
Mr. McElhinney said he could not care less whether Mr. Piland was a nurse or a doctor or a physician assistant.
"All I know is I got treated quickly and excellently," he said, smiling sheepishly. A few minutes later he was gone, likely to snag another splinter in the not-too-distant future. Mr. Piland or the other three PAs now in rotation — D.J. Peters, Philip Piette and Lateefah Pree — would be ready.
And that is exactly what the hospital's enhanced physician assistant program is supposed to do. The addition of PAs was one of the components of a blueprint titled "Martha's Vineyard Hospital Emergency Department Flow Initiative," that was developed by new emergency department director Dr. Jeffrey Zack and his team, and which he presented to the hospital board for their approval at a meeting on December 11, 2010.
Granted, that day there was a low turnout in Emergency, one of the few enterprises on the Island where "low turnout" translates to a good day for all parties concerned: doctors, nurses, PAs, and especially for those who otherwise would have been called "patients."
But the last weeks of June provided Mr. Piland, hospital executives, and especially Dr. Zack, time to make any adjustments before the tourists and summer people hit the proverbial fan. The number of cases seen in the emergency department will more than triple starting July 1, jumping from 25 to 30 a day in winter to typically 85 to 100 in summer.
"When the new building opened last June, we never had time to breathe," said Tim Walsh, president and CEO of the hospital. "We got off to a rocky start in terms of patient flow. Now we're ready."
"With this new system, the brainstorm of Dr. Zack, I like to think we are ahead of the curve on most hospitals our size in the country," said Tim Sweet, chairman of the hospital's board of directors (See, Feb. 9, "Hospital moves to cure ER ills").
Along with the PAs who ease the burden on a half-dozen ER doctors (plus Dr. Zack) in summer, a new wifi system enables PAs and nurses to escort a patient right to a treatment room and, with a laptop, register them, issue them an account number, and initiate blood and other vital tests. This alleviates those sometimes tediously long delays in the waiting room, when a new arrival awaiting registration must not only bear the pain of a sunburn, stubbed toe, fishhook caught on some undesirable part of the body, or something more critical, but also witness others in similar or more excruciating pain.
Sitting there waiting used to be no day at the beach, admitted Dr. Zack, who was promoted to director last year after working at the hospital since 2002. "While we are still tweaking certain areas and procedures, getting used to communication between and among sections of the space, this is such a vast improvement over the past." He said he tracks patient wait and flow every day and estimated that wait time already has been reduced on average by an hour under the new system.
"The key to success in any emergency department is flexibility and flow," he said, standing last Sunday at 7:30 am by the new "fast-track" station surrounded by a total of 16 treatment rooms, up from the 8 rooms in the previous configuration. Luckily, the majority of the rooms were empty on an early Sunday morning. But that, he said, would likely change over the July 4th weekend.
Fast-tracking is where the PAs come in at an especially crucial stage to expedite patient flow in such cases as lacerations, colds, rashes, splinters, tick bites, stubbed toes, sunburns and the like.
Called "mid-level providers" in medical terminology, PAs are qualified to conduct physical exams, diagnose and treat illness, order and interpret tests, counsel on preventive health care, assist in surgery, and write prescriptions. Throughout the U.S., according to the American Academy of Physician Assistants, this brigade of healthcare pros treated about 257 million patients and prescribed or recommended about 332 million medications in the year 2008.
For Mr. Piland, 44, it's a job he had not planned on but now finds it is perfect for him and one he's perfectly qualified to undertake. Originally from Prospect, Connecticut, he spent six years in the Air Force, stationed at Loring Air Force Base, in Limestone, Maine (now closed), where he became a medic.
"I was always intrigued by medicine," he said. "I've always wanted to find a way to give back."
At Quinnipiac University in Hamden, Connecticut, he earned a certificate as a physician assistant. In 1991, he got married, and his wife, Mary Lou, became pregnant right away. With the need to support his small family, while other medical paths may have also been appealing, he dove into a career at a PA and has never looked back. Since then he has worked at the VA Medical Center in West Haven with HIV patients; in the outpatient transplant clinic at Yale School of Medicine in New Haven; and in the emergency department at St. Mary's Hospital in Waterbury, all in Connecticut.
He came to the Island in 2008, and joined the MV Hospital in April of this year. He and Mary Lou, who now also works at the hospital as a medical secretary, and their three sons live in West Tisbury.
"The hospital administration has done a wise thing to incorporate more PAs in its fast track and urgent care healthcare system," he said. "I hope to be around here a long time, helping raise the bar on health care here."
With that, he was off to Treatment Room 8 where a lanky James Todd, a Martha's Vineyard Regional High School basketball standout from the Class of '09 sat, his long legs hanging over the edge of a hospital bed, complaining of a fever. Mr. Piland immediately ordered tests to determine if it was tick-related.
One can rest assured that over the next weeks Piland and Co. will order plenty more such tests.
In the waiting area there's a bronze plaque on the wall that few hospitals in the world can boast: "The Emergency Department was made possible through the generosity of Margaret Whitton and Warren Spector." Mr. Spector is a summer Chilmarker, the former Bear Stearns co-president and executive producer of Tashtego Films, with his wife, Ms. Whitton, the actress who is president of the film company. Mr. Spector was chairman of the capital campaign committee that helped raise money for the $48 million new hospital.
And while summer wealth like that helped build such a shining new hospital, it's the work-a-day, unsung heroes of ER to whom too many people living on or visiting the Island will show more gratitude, as the summer rolls on and inevitable medical emergencies arise with the predictability of rainy days and backed-up traffic at Five Corners.