In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. They are making a difference in healthcare. This is the story of Peter Semczuk, DDS, MPH.
This profile was published in the December, 2014 issue of HealthLeaders magazine.
"I can count on one hand the number of bad days I've had here in 20 years. I can't wait to get to work."
Peter Semczuk, DDS, MPH, has been working in New York City for almost 20 years, and during that time, he has developed an appreciation that colleagues in the industry often look to the larger systems to see how they take on the challenges.
As the vice president of clinical services for the Bronx-based Montefiore Medical Center and executive director for Montefiore's Moses Campus, Semczuk oversees one of the busiest emergency departments in the country, treating more than 370,000 patients a year. "I think any time people are faced with industrywide challenges, you look to a bigger system like Montefiore, and see how Montefiore is doing things," he says.
"There absolutely are expectations around the way in which we are performing, the kind of services we're providing, the way in which we staff our emergency departments, and acting as an industry leader for new ways of thinking about emergency services."
One example came in March 2013 when the state of New York partnered with Montefiore to create the first freestanding ED in the state, using the facility from the oft-troubled Westchester Square Campus. Montefiore's success in the Bronx allowed the state to be confident that freestanding EDs could succeed in the big city, which led to another role for the industry leader: spokesman.
"I think the activity and work that we've done there has caught the attention of the state," says Semczuk. "We've probably spoken with 10 to 12 additional systems in the state about what it's like to run a freestanding ED. Several in turn have responded by opening freestanding emergency rooms."
Since the Westchester Square freestanding ED opened, efforts have been made to stabilize the physician group, incorporate strong ED nurses, and introduce a five-level triage system.
Montefiore runs six hospitals throughout New York City, which helps its innovation efforts. Having multiple campuses offers an advantage when leaders want to try out new methodologies. Moses Campus, the largest in Montefiore's system, was the first to use the "pull 'till full" method, which is now being instituted across the entire Montefiore system.
Semczuk and his clinical team saw that it didn't make sense to have patients sit in waiting rooms while space was available in the ED. To remedy this issue, Montefiore pulls patients in once it has determined where they need to go, and executes tasks at bedside that would normally be done outside of the ED setting, such as registration. Incorporating this technique enabled Semczuk and the clinical team to challenge themselves and the status quo, leading to benefits he describes as multifactorial.
"Once patients are inside, they are less likely to leave," he says. "You've got them within your care environment. You've already triaged them. You know how sick they are. You know how soon they are going to be seen. You've got all of their registration and financial information done. They are likely to remain inside as patients because they are already in that care environment."
Another innovation that Montefiore slowly rolled out is one that Semczuk says all emergency departments need to do in the future. The 24/7 follow-up office is not common within emergency medicine, and didn't begin to formulate at Montefiore until the late 1990s, when the Department of Emergency Medicine was established at Montefiore.
The new department saw a dramatic rise in patient volume as the community became aware of the opportunities to see board-certified emergency medicine physicians around the clock. The 24/7 system was implemented as Montefiore noticed that many patients didn't have primary care physicians, and those who needed specialty follow-up care didn't have easy access to specialty services. The 24/7 follow-up offices link patients to primary care networks. Now, with a new physician contact, the patients are discharged with a follow-up appointment set for within 48 to 72 hours of their ED visit.
While the 24/7 offices are incorporated across Montefiore, they are not widespread around the country. Semczuk says that the 24/7 offices are costly, and require numerous employees to work around the clock. While the initial cost may seem high, Semczuk sees the 24/7 clinics as a cost avoidance for hospitals, and a great asset for patients.
"When you have a system set up like this that affords a patient with an appointment with a primary care physician within 48 to 72 hours, our studies have shown that patients actually do follow up, and they tend to remain with their primary care physicians over time, and they only use the emergency room for those things that they absolutely need to," he says.
Another way the system improves operations and enhances the patient's experience is through the use of nurse practitioners who serve as navigators for patients who enter the ED. The navigators work with other clinicians to help make the process easier for the emergency physicians by scheduling appointments, ordering procedures such as stress tests, or determining placements for nursing homes or other ancillary services.
Semczuk considers patient navigators to be one of the most important investments that Montefiore has made over the past three years, and is planning on bringing in more navigators in the future, which goes in line with the system's goal of expanding and growing more efficient as demand continues to grow.
Montefiore will be dealing with challenges that many other EDs will also face in the future, including increasing patient volumes and labor shortages of board-certified physicians. Even with the changes and challenges facing the industry, Semczuk remains upbeat.
"I can count on one hand the number of bad days I've had here in 20 years. I can't wait to get to work."