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Nej MP 1701449
Nej MP 1701449
Nej MP 1701449
be unfamiliar to them: What staff round providers, including physi- whose quality we have no way of
members are on island and on cians and physician assistants, as judging in advance. Instead, we
call? Is orthopedics here? Whats well as some longtime summer can focus on becoming fluent in
the current volume? Will the team members, and supplement- the type of medicine that best
weather prevent MedFlight from ed them with rotating clinicians serves our island.
getting here? from its higher-volume hospitals. Disclosure forms provided by the authors
Assembling the summer ED It took on responsibility for sched- are available at NEJM.org.
team became increasingly diffi- uling, peer review, and quality From Nantucket Cottage Hospital, Nan-
cult. The usual cadre was aging, metrics, while building awareness tucket, MA.
and some clinicians chose not to of Nantucket-specific aspects of
1. ODonnell J, Unger L. Rural hospitals in
return. Seeing that the model clinical judgment, so that we no critical condition. USA Today. November 2014
that had evolved wasnt serving longer have to constantly reorient (http://www.usatoday.com/story/news/nation/
us and couldnt be sustained, we personnel. This model forces a 2014/11/12/r ural-hospital-closings-federal
-reimbursement-medicaid-aca/18532471/).
began to think about an alterna- careful comparison between the 2. Wishner J, Solleveld P, Rudowitz R, Para-
tive. Our chief medical officer cost of subcontracting ED staff- dise J, Antonisse L. A look at rural hospital
identified an emergency staffing ing and the cost of directly hir- closures and implications for access to care:
three case studies. Kaiser Family Founda-
group MEP Health, now called ing six or more ED physician and tion, 2016 (http://kff.org/report-section/a-look
U.S. Acute Care Solutions PAs, even if we could recruit -at-rural-hospital-closures-and-implications
that, far from being daunted by a them to the island and figure out -for-access-to-care-three-case-studies-issue
-brief/).
new problem, was intrigued by how to enable them to buy into 3. Massachusetts Department of Public
Nantucket and its unusual cir- the housing market. Most of all, Health. Lyme disease surveillance in Massa-
cumstances. Aiming to balance it takes advantage of the continu- chusetts, 2014 (http://www.mass.gov/eohhs/
docs/dph/cdc/lyme/lyme-disease-surveillance
delivery of high-quality medicine ity and stability of our year-round -2014.pdf).
an ever-evolving goal with ED base, while allowing us to 4. Collins M. Staffing an ED appropriately
continuity provided by a core stay current as medicine evolves. and efficiently. American College of Emer-
gency Physicians, 2009 (https://w ww.acep.org/
team that understands the puz- Now we dont have to worry clinical---practice-management/staffing-an-ed
zle we face, we negotiated a trial about filling our schedule for -appropriately-and-efficiently/).
agreement. MEP Health became next summer or about depending DOI: 10.1056/NEJMp1701449
the employer of the existing year- on a locum agency for physicians Copyright 2017 Massachusetts Medical Society.
Rural Health Care