ED becomes 'satellite' when hospital closes
Interdisciplinary task force paves way for transition
How would you like to be told that the hospital that houses your ED — the large, "mother" facility that receives your patients for admission and provides a host of ancillary services that makes the running of your department go more smoothly — was going to shut down, and that you were going to have to transform into a satellite ED (SED)?
That's exactly what happened to the ED leadership at the 335-bed Muhlenberg Regional Medical Center of the Solaris Health System in Plainfield, NJ. The system originally included Muhlenberg and JFK Medical Center in Edison, NJ, but last spring, word began circulating that Muhlenberg would close In fact, most of the facility did shut down in August 2008.
The shutdown was mandated by the state, which also directed that the ED remain operational, although under vastly different circumstances. For example, the ED would no longer be able to admit patients "upstairs," but rather to JFK or another nearby facility. The ED director at the time, Ken Herman, DO, now the chairman of emergency medicine at JFK, and the associate director at the time, Sam LaCapra, MD, FACEP, who now is medical director of what is called the JFK Satellite ED, Muhlenberg Campus, began working together during the transition.
The key to a successful transition was the establishment of a task force, they agree. "We started thinking about forming the task force to assemble all the possibilities and initiatives we had to start organizing for the conversion," explains LaCapra.
This operation was interdepartmental, adds Herman. "We had to bring together managers from different departments to determine what each would require in order to get a satellite ED up and running, so we could formulate a final proposal with funding attached to it to be submitted for approval," he said.
The group included representatives from hospital administration, emergency physicians and nursing, laboratory services, pharmacy, radiology, information systems, finance, registration/admissions, respiratory, dietary, central distribution, sterile processing, housekeeping and linens, and security/ambulance/transportation services.
The SED Task Force Committee focused on identifying:
- regulatory requirements;
- scope of care;
- services;
- administrative and structural organization;
- staffing needs;
- supplies and equipment requirements;
- quality improvement metrics;
- policies and procedures development;
- high-acuity/high-risk clinical processes;
- transfer agreements/arrangements.
In the transformation process, the ED leaders gained greater appreciation of just how interdependent some of these departments are when it comes to patient care.
"One example of how addressing one process can affect different departments is the transfer of a patient for additional testing not available at the satellite emergency department [SED]," notes LaCapra. "In order to accomplish this process, the patient must first be informed of the reasons and possible outcomes of the process, and there has to be a call made to schedule the test at the affiliated hospital and make sure the testing department is ready to accommodate the patient."
Next, appropriate transportation needs to be coordinated, and there has to be a bed and nursing staff available at the hospital to monitor the patient pending the results of the test, he says. "Communication between the satellite ED and the hospital's main ED needs to occur in case the patient's condition were to change and require acute intervention," LaCapra says. "Results of the testing need to be obtained expeditiously and integrated with the hospital's and SED's electronic medical records."
Staff education also was critical. This education included the SED staff, hospital medical staff and key departments, area and local ambulance squads, and mobile intensive care units. "We had to educate all personnel — not only at the satellite, but at the receiving hospital — as to what to expect and what expectations we had for them for the safe care of patients coming from the satellite," says Herman.
This process included several inservices. LaCapra says, "We would meet with staff and basically go over different scenarios involving clinical as well as administrative situations. For instance, if admission is required, who do we call? And how that does that process run from the satellite side and the main hospital side?" The satellite has its own lab, he notes, so some basic services still are available in-house. "That helps expedite patient flow, and we still have radiology support 24/7 on a PACS [Picture Archiving and Communication System], so the radiologist at JFK can interface for reading films like we did before."
Finally, says LaCapra, he and Herman contacted other established SEDs, using their experiences to assist with planning. Other New Jersey facilities that have SEDs include AtlantiCare Regional Medical Center, which has a satellite ED on its Kessler Campus in Hammonton, NJ, and Ocean Care Center, which has an SED in Point Pleasant, NJ.
How would you like to be told that the hospital that houses your ED the large, "mother" facility that receives your patients for admission and provides a host of ancillary services that makes the running of your department go more smoothly was going to shut down, and that you were going to have to transform into a satellite ED (SED)?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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