New PMO role at Pasqua creates safer hospital at night

August 31, 2017

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New PMO role at Pasqua creates safer hospital at night

A new overnight physician role at Pasqua Hospital is ensuring continuous patient care into the wee hours of the morning, providing nurses with on-site consultation and improving patient flow from Emergency to the surveillance and medicine units.

Dr. Tania Potgieter is one of a number of critical care associates who serve in the newly created Pasqua medical officer (PMO) role. Photo credit: Medical Media Services

“The Pasqua medical officer (PMO) position is a real game changer,” said Dr. Hennie Van der Merwe, section head of critical care associates (CCAs), Department of Medicine. “It glues things together. Things tend to come apart at night. We lead the team and keep the hospital safer.” 

The PMO role, which launched June 19, is filled by CCAs – experienced physicians who provide on-site coverage of acutely unstable patients requiring immediate care without undue delay when the attending physician is not immediately available. The PMO, who works from 5 p.m. to 8 a.m., admits patients to the hospital from the Emergency Department and cares for previously admitted patients through the night. 

“There are multiple demands on the PMO that require the physician to move through the hospital throughout the night,” said Van der Merwe. “We triage the demands, which vary from being the code captain in the Medical Surveillance Unit, to talking to a family as they arrive, to managing a patient’s chest pain on 3D. The strength of being part of the in-hospital team at night is it gives us the confidence to say we are increasing safety.” 

He noted the role prevents gaps in care. “The PMO can speed things up, move the patient to a different area earlier. You don’t have to wait till the patient codes (goes into cardiopulmonary arrest) to make a difference.” 

Quicker patient flow is an unintended consequence of this role, said Dr. Pieter Minnaar. “It’s definitely improving patient flow. We don’t have the statistics to prove it but, in Emergency, you can see it. Patients used to sit waiting for the MRP (most responsible physician) to see them. Now they’re moved to the units.” 

Added Van der Merwe, “It’s like a relay team – we continue the momentum started by Emergency physicians. We move this patient forward through the system at night, sometimes redirecting as needed, and then hand over the care of the patient in the morning to the day time teams.” 

Van der Merwe saw the value of the role first hand during a PMO shift when a 4A patient’s condition began to deteriorate. “In most circumstances, the nurse would have called a Code Blue (to activate the code team). Because I admitted the patient and was doing my prevention of decline round earlier, the staff talked to me and I phoned the patient’s wife to talk to her about her husband’s wishes. I was able to make sure the patient was admitted to the right ward and the patient’s and family’s wishes were observed. It’s a patient-focused design.” 

Van der Merwe and Minnaar said that, as with any new role, they’ve experienced some hiccups. The newly created Pasqua medical working group (PMwG), comprised of two CCAs, two hospitalists and two internists, will address these issues when it meets this fall. Van der Merwe is the PMwG lead and Minnaar is the second CCA representative. 

“If we can fine-tune the PMO role here, we can make this shift work anywhere,” said Van der Merwe. “This role is resulting in a safer hospital. This is something to be proud of.” 

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