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Dan Long has been vice president of integrated healthcare markets (managed care) for GW Heritage Products at Research Triangle Park, NC-based GlaxoSmithKline since January 2001. Prior to this, he was the group director of strategic operations for managed healthcare, responsible for directing marketing and contracting strategies for managed markets. Long joined Glaxo in 1988 as a sales representative and has also been an account manager and the director of managed care for the Pacific region. Before joining Glaxo, he was a registered nurse and the manager of a variety of emergency departments, including Children's Hospital and Kaiser Permanente. Long is also a member of the Pharmaceutical Representative editorial advisory board.
There is no medical setting in which a doctor or nurse can have a more dramatic impact on a patient's life than in the emergency room.
There is no medical setting in which a doctor or nurse can have a more dramatic impact on a patient's life than in the emergency room. The same is true for representatives of the pharmaceutical industry: The emergency department holds tremendous potential for improving patient care. The challenge is how to best provide information to physicians in this stressful environment and avoid interfering with patients' immediate needs.
Emergency departments are tremendously busy environments. Some see only a small number of patients; others see more than 100,000 patients a year. The average department sees at least 30,000 patients annually. The atmosphere may change from extreme quiet one minute to chaos the next. Frequently there is an acute care center to take the least ill patients, who can be treated more quickly.
Emergency departments are categorized as level I, II or III departments. Level III departments are trauma centers with dedicated operating room teams on site; usually they are associated with teaching hospitals and frequently they have the capacity to receive critically ill patients via airlift.
A level II emergency department is representative of most community facilities and has 24-hour physician coverage in the department. Operating room and other specialty M.D.s have to be available in the department within an hour.
An example of a level I emergency room is a small, rural department with a single physician or a physician's assistant providing coverage in two-hour blocks.
Although emergency departments vary widely in staffing and resources, they do have many things in common. The pharmaceutical representative who understands this environment can make himself or herself a bigger asset to the physician and, most importantly, to the patient.
Among the common characteristics of emergency departments to be considered by pharmaceutical representatives are:
The closed environment. Many institutions have formal policies that declare the emergency department a closed environment. There are many good reasons for this limited access, including patient confidentiality and security. Although some departments are formally open, there is no room in the staff routine for visitors. Representatives should realize the stress facing the staff but also understand that emergency department staffs usually are the most informal medical staffs with the best-developed senses of humor. Once you get to know the individuals there, you will find these relationships among your most rewarding.
Specialty vs. general medicine. The emergency department physician has the broadest training of anyone in medicine. It is amazing how many specialty areas a doctor must know to practice here â obstetrics, orthopedics, plastic surgery, cardiology, advanced life support (pediatric and adult), psychiatry, neurology and more.
The list of procedures and therapies to perform is endless and includes minor surgery, intravenous therapy, rape exams, casting, splinting, suction, defibrillation and more. And the physician must be armed with amazing knowledge of pharmaceuticals including, but not limited to cardiac drugs, ulcer drugs, oral and intravenous antibiotics, vaccines, muscle relaxers, neuroleptics, anti-depressions, tranquilizers and asthma drugs. If the doctor or nurse isn't prescribing medicines, he or she is trying to identify drugs brought in by patients, sometimes jumbled in a large paper bag, sometimes ingested.
So, whatever drug information you're prepared to deliver, that's what the emergency department physician will need to know.
Education. The research-based pharmaceutical industry is one of the most complete providers of high quality medical education in America. Do not forget that the medical and nursing professional is in need of continuing education to retain current knowledge as well as licensure and to advance that knowledge to meet new and changing needs. Do not forget that you are an in-depth bearer of pharmacological information and, if delivered in the right venue, you will be giving the physician new tools to do his or her job, as well as playing a role in improving outcomes for patients.
Business acumen. Health care professionals today must also concern themselves with business issues, including reimbursement and questions of access to certain care or therapies. The pharmaceutical representative who works with emergency department doctors and nurses must become aware of those business pressures too. For example, will emergency room patients who leave with a prescription for your drug face access problems? If so, the emergency department physician is unlikely to prescribe that medicine. The pharmaceutical representative who is aware of potential barriers can do more to help the physician and, ultimately, the patient.
Patient flow. The key to success in a busy emergency department is the rapid, accurate diagnosis and disposition of patients. As a result, some key concerns for the emergency department physician will be more rapid and effective treatment of an illness as well as a medicine's interactions and safety profile.
Special journals. A pharmaceutical representative can better understand and help meet the challenges of emergency department professionals by turning to the medical library. Good examples of reading are The Journal of Emergency Medicine or emergency nursing publications. Frequently, such magazines address pharmacological approaches to illness or injuries.
Access. A planned and thoughtful approach to visiting the emergency department is critical to improving patient outcomes without interrupting critical care. Never try to see staff during times that are clearly busy. Statistically, early mornings are the quietist. The smartest approach is to build relationships by appointments with key staff. The nurse manager or emergency department physician group head is a good start.
Nursing almost always has monthly staff meetings at which you might be allowed to present information, especially if you can provide continuing education material. Additionally, many nurses are active in the local chapter of the Emergency Department Nurses Association. Locate the city chapter president and make an appointment. City, state and national EDNA chapters have regular meetings that feature pharmacological treatments for patients in the emergency room.
Physician groups may be small, covering one aspect of emergency care. But they are often part of large, regional emergency groups covering multiple hospitals. Opportunities exist from informal presentations to large formal programs that may include corporate level involvement. The above venues will allow you to deliver information to many providers and to start building personal relationships.
The emergency department is a challenging environment for all who work there - and for the pharmaceutical representative who hopes to have an impact there. But with planning and some advance research, the emergency department offers a big opportunity to help health care providers and their patients while building powerful testimony to the efficacy of your (or your competitors') medicines. PR