Board Meeting Minutes

American Academy of Emergency Medicine
Minutes of Board of Directors Conference Call
November 13, 2001

IN ATTENDANCE: Robert McNamara, MD; Joseph Wood, MD, JD; Drew Fenton, MD; Howard Blumstein, MD; William Durkin, Jr., MD; Antoine Kazzi, MD; Geoffrey Mitchell, MD; Margaret O=Leary, MD, MBA; Raymond Roberge, MD, MPH; Tom Scaletta, MD; Scott Weiner, MD; Leslie Zun, MD. Absent: Carol Barsky, MD. Staff: Kay Whalen and Beth Wilson.

Dr. McNamara welcomed everyone to the call and turned the Board=s attention to the first agenda item.

I.   Approval of September 2, 2001 Board of Directors Meeting Minutes

Dr. McNamara drew the Board=s attention to the draft minutes that were included in the agenda packet and asked if there were any corrections to these minutes. There being none, Dr. Wood moved and Dr. Scaletta seconded that the September 2, 2001 Board of Directors meeting minutes be approved. MOTION PASSED UNANIMOUSLY.

II.   President=s Report

Dr. McNamara noted that he had appointed a task force to draft an AAEM position statement on thrombolytics chaired by Dr. Deepi Goyal.

Dr. McNamara also reported that there will be a terrorism link on the front page of the AAEM website.

III.   Treasurer's Report

Dr. Fenton noted that AAEM's financial position had not changed much since the September Board meeting. Most financial activity occurs in the earlier part of the year. Ms. Whalen noted that AAEM would pay the JEM invoice soon. However, she was waiting for some clarification from the publisher before paying this invoice.

AAEM is also waiting for a financial report from the local organizers of the Stresa meeting.

IV.   Membership Report

Ms. Whalen reported that the membership totals included in the agenda packet represented dues payments for 2002. All categories of membership were slightly ahead of last year's pace. Dr. McNamara reminded the Board that AAEM's 2001 membership numbers totaled more than 3,000.

V. AAEM Position Statement on Admission Orders

Dr. Scaletta outlined the points included on the proposed position statement on admission orders that he had drafted and asked if the Board had questions or comments on the statement.

Dr. Durkin moved and Dr. Wood seconded that the sentence which read, "Use of emergency department nurses to transcribe admitting physician orders is discouraged as they are not the nurses responsible for inpatient care." be deleted from the position statement. MOTION PASSED 5-2-4.

Next, Dr. Wood moved and Dr. Durkin seconded that the following position statement be approved:

AAEM Position Statement on Admission Orders

WHEREAS typical emergency physicians do not practice inpatient medicine;

WHEREAS admitted patients benefit by one primary physician orchestrating a treatment plan and by these orders being scrutinized by the nurse that will initiate those orders;

WHEREAS emergency department nurses, due to increasing patient volumes and nurse shortages, rarely have sufficient time to transcribe admitting orders;

WHEREAS there is often a time interval between admission and the admitting physician writing or relaying hospital inpatient admission orders;

WHEREAS patient treatment should be a continuous process despite any time gap between admission and completion of hospital inpatient admission orders;

Therefore be it resolved that the American Academy of Emergency Medicine believes that, in the interest of patient care, hospital inpatient admission orders should be formulated by the admitting physician and relayed directly to the primary inpatient nurse who will care for the patient.

The Academy believes that it is acceptable for emergency physicians to write Holding Orders, which define any necessary treatment and assessment parameters required in the interval until completion of admission orders.

The Academy encourages hospitals to create policy that ensures a short interval for completion of inpatient admission orders. MOTION PASSED UNANIMOUSLY.

Dr. Scaletta then moved and Dr. McNamara seconded that the Examples of Holding Orders which read:

Example of Holding Orders

Admit Type

• Unit/ward
• Status (e.g., observation, full)
• Diagnoses
• Isolation (if necessary)

Responsible Parties

• Attending
• Resident Service
• Consultants

"Status Quo" Parameters

• Activity (e.g., bedrest or BRPs with assistance)
• NPO (motivates nurse to get further orders)
• Ventilator settings/Supplemental O2 (if necessary)
• Saline lock or IVFs (fluid/rate)
• Medications (drip rates)
• Vitals per unit routine (can include special assessments like neuro checks)

"On-notice" Directives

• Notify resident service/admitting attending upon arrival to floor
• Notify resident service/admitting attending if any abnormal vital sign/other condition change
• Call hospital medical director if full admission orders not written with 4 hours
• Above orders are limited to a 4 hour time period

be attached as an appendix, but not be included in the position statement itself. MOTION PASSED 10-1-1.

VI.   AAEM Legal Opinion on Restraint of Trade Issues

Dr. McNamara then led the Board in a discussion regarding the need for AAEM to obtain a legal opinion on the organization's policy to exclude contract management groups from our exhibits and job bank. The Board reviewed previous opinions obtained from legal experts regarding this issue. After much discussion, the Board decided that, before another legal opinion was sought, the legal question that the Board would like addressed needed to be more tightly defined. Drs. Scaletta and Wood agreed to serve on a task force to develop a draft of what the Board was looking for.

VII.   ABEM Nomination Process

Dr. McNamara then reminded the Board that ABEM had opened its nomination process. AAEM would like to nominate one or two qualified individuals to serve on the Board. Dr. O=Leary commented that ABEM preferred its Board members to have served ABEM in some way prior to their appointment to the Board. Dr. Blumstein volunteered to obtain a listing of ABEM examiners that could be cross-checked with AAEM=s membership database.

Since nominations need to be sent to the Board by December 1st, Dr. McNamara moved and Dr. Fenton seconded that the Executive Committee determine the best candidate(s) to be sent to ABEM. MOTION PASSED UNANIMOUSLY.

VIII.   2002 Scientific Assembly

Ms. Whalen reported that the 2002 Scientific Assembly brochure would be mailed shortly. A copy of this brochure was included in the agenda materials.

The Education Committee has already begun to identify the process of choosing topics and speakers for 2003.

IX.   Templates

Dr. McNamara reported that AAEM templates are now being used in hospitals. He would be participating in a conference call to discuss a marketing plan for the templates in the next few weeks.

Ms. Whalen reminded the Board that income realized for template sales would be subject to unrelated business income tax.

X.   AAEM Resident Section Update

Dr. Weiner reported that the activities of the AAEM Resident Section were going well.

The Resident activities at the Scientific Assembly will all be held on Saturday including the JEM abstract session and the AAEM Resident Section Board meeting.

Other activities of the Section include expanding the website to include more information for medical students, an educational session during the SAEM meeting, a survey of contract management companies and continuation of the Student Rules of the Road.

Also, AAEM had made a donation to the New York Fire and Police Departments in memory of Cathy Lisa LoGuidice, the sister of Michael LoGuidice, DO, AAEM Resident Section Vice President.

XI.   New Business

Ms. Whalen noted that there has been some confusion regarding the length of the 2002 Candidates= Statements and what is included in the statements. Dr. McNamara asked Ms. Whalen to determine the last policy regarding Candidates= Statements that had been approved by the Board. This policy would be communicated to all candidates.

Next, the Board turned its attention to Dr. Jim Cohen=s suggestion that AAEM produce membership cards. After discussion, the Board decided not to pursue membership cards at this time.

Dr. Mitchell, as the AAEM Board liaison to the International Committee, then asked for direction in determining AAEM=s position on international affiliation requests. The Board asked him to have the International Committee prepare a proposal with recommendations on this issue.

There being no further business, the Board of Directors conference call meeting was adjourned.

Respectfully submitted,

Kay Whalen
Organizational Director