State of the art replaces state of confusion at ED
New facility features high-tech, creative elements
Less than two years ago, the ED at Carondelet Health Network’s St. Mary’s Hospital in Tucson, AZ, was an 8,000-square-foot facility designed to handle 25,000 patients a year, but treating about 50,000. There was no storage space, one utility room, and pumps and carts were sitting in the hallways.
Today, staff are working in a new 24,000-square-foot center, soon to be expanded to 30,000 square feet in a second phase. In total, there will be 53 treatment rooms, compared to the 32 total beds in the previous facility.
But just as impressive as size of the new facility is what is contained inside. In many ways, this design may represent the ED of the future. For example, it includes a picture archiving communication system (PACS) that allows physicians to access imaging test results on a computer screen. Physicians using PACS also will be able to access test results from their homes or offices.
The staff use a wireless communications system called Vocera, which will enable them to communicate instantly with any staff member in the now-spacious center. (For more on how technology helps the St. Mary’s staff, see box, below.)
Design considerations are particularly creative. For example, the center has rooms built specially for isolating patients with infectious diseases. It also boasts a decontamination room with access from outside the hospital.
"You pull the ambulance right into the bay; and once under the entrance canopy, you can either bring patients through a sliding glass door into the ED or through a door on the right that opens right into the decon room," explains Herb McReynolds, MD, the chair of emergency medicine at St. Mary’s.
"Then, in case of mass casualties, we also have outside freestanding [decon] tents that can be inflated and set up in five minutes." The first critical care room on the left of the entrance is one of the isolation rooms for nontoxic patients, he adds.
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Technology aids imaging, staff communications The advanced technological systems in the new ED at Carondelet Health Network’s St. Mary’s Hospital in Tucson, AZ, have been a tremendous benefit to the ED staff, reports Herb McReynolds, MD, the chair of emergency medicine. For example, the picture archiving communication system (PACS) allows physicians to access imaging test results on a computer screen. It’s a digital imaging system, McReynolds says. "You take a cassette, put it in a reader, and within 50 seconds, the image is available," he says. The image also is archived into St. Mary’s computer system, he notes. Within a minute of walking out of the room, you can look at film, he says. There is a central reading monitor at the physicians’ work areas; and in the two code rooms, there is a monitor on an OR-type boom by each bed. "I don’t even have to leave the bedside to read the results," McReynolds adds. The program also is installed on the computer at his work area, so he can pull up images there as well, he says. All future EDs should have this technology, McReynolds asserts. "Film is going the way of the dinosaur — even more quickly than the dinosaurs — and it should be," he says. "With digital systems, you can invert the image, which is very helpful for tube placement; move the image around; enlarge it; sharpen the focus; and even measure the angles of fracture without having to get out a protractor." The wireless communication system badges from Vocera in Cupertino, CA, "are so small and light they can be worn around the neck or clipped onto a physician’s white jacket," McReynolds notes. It has different commands; for example, he can push one button to call the ED charge nurse. You can communicate with anyone in the emergency center without having to use an overhead page, McReynolds says. It has been very helpful, he explains. "For example, I can talk to the clinical supervisor if I need an ICU bed immediately. I have been at the bedside with a neurosurgery patient and talked to a neurosurgeon at the university, describing the patient’s condition, while I’m right at the bedside." He notes the badges themselves cost about $300, with a licensing fee of about $30 per badge per month. |
Making design decisions
The ED staff enlisted the services of FreemanWhite, a professional services firm with offices in Charlotte, NC; Raleigh, NC; Minneapolis; and San Diego, to help determine what the new facility would look like.
"They came to our hospital and looked at our physical issues and our work flow processes," McReynolds recalls. "We also looked at the types of patients we have and our top 10 or 20 diagnoses."
This analysis is what led to the special isolation considerations, he explains. "It was not so much because of potential terrorism, but because of our HIV population, the number of elderly people who are immunosuppressed from chemotherapy, and the number of diabetics — all of which comprise a large population of immunosuppressed patients," McReynolds says.
They see a number of immunosuppressed and ill patients that may require isolation, he points out.
"We have one isolation room that can handle a critical care patient — closer to the nursing station, ambulance entrance, physician work area, and so forth — and another that is off of our triage area that could manage someone who is not critical," McReynolds explains.
Much of the design and technology considerations came from a review of other hospitals via site visits by the St. Mary’s team (ED staff, including physicians, nurses, clerks, techs, and management), or designs FreemanWhite brought with it, he says.
In terms of building a state-of-the-art ED, St. Mary’s is on the right track, says Brian Keaton, MD, FACEP, vice president of the American College of Emergency Physicians in Irving, TX, and director of emergency medical informatics at Summa Health System in Akron, OH.
The design element that keeps the decontamination room outside the hospital "is ideal," he says. "The ability to move segregated patients into the facility is also ideal."
The technology also is indicative of what ails EDs will have in the future, though Keaton adds several caveats. "The ED should not function independent of the enterprise [hospital or system]; you should be part of it," he advises. "The key to a PACS system is not that the ED alone has it, but that the enterprise makes it available to everyone involved in taking care of the patient — now and later on."
There also is another key area that technology can and should address, in addition to the communication and imaging advances at St. Mary’s. "Patient flow has become critical, so tracking systems are becoming so important," Keaton notes. "The technologies allow you to track individuals and equipment."
In his own ED, Keaton explains, he is able to track a patient who has an order for a portable X-ray, for example. There’s a tracking badge on the patient and on the boom of the portable X-ray machine, both of which send infrared signals to the same receiver. A change in the icon from blank to red says the X-ray has been done, and blue means it’s finished and he can pick it up and read it.
"These types of systems are becoming the norm — not only because storing digital data [from X-rays] is so much quicker and faster than traditional film, but because the results are always available to multiple people at the same time," he adds.
Sources/Resources
For more information leading edge ED design and communication trends, contact:
- Brian Keaton, MD, FACEP, Director of Emergency Medical Informatics, Summa Health System, 525 E. Market St., Akron, OH 44310. E-mail: bfkeaton@ earthlink.net or [email protected].
- Herb McReynolds, MD, Chair, Emergency Medicine, St. Mary’s Hospital, 1601 W. St. Mary’s Road, Tucson, AZ 85745. Phone: (520) 872-6264. E-mail: [email protected].
For more information on ED design, contact:
- Jerry Turner, Group Vice President and Financial Officer, FreemanWhite, P.O. Box 44517, Eden Prairie, MN 55344. Phone: (952) 886-7145. Fax: (952) 886-7501. Web: www.freemanwhite.com.
- ER-One is a project established by the federal government about one year ago, and the ultimate goal is to build a prototype "all-risks" emergency medicine center. Web: http://er1.org.
For more on wireless communications for the ED, contact:
- Vocera Communications Inc., 20600 Lazaneo Drive, Third Floor, Cupertino, CA 95014. Phone: (408) 790-4100. Fax: (408) 790-4101. Web: www.vocera.com.
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