August 30, 2008

Manhasset’s the Place to Have an Emergency

By Claude Solnik

When Grace M. Conti drove her 88-year-old mother, whom she thought was having a heart attack, to the emergency department North Shore University Hospital at Manhasset she was shocked, not because the ED was a foreboding place packed with crowds, but because it was anything but that.

"I noticed how upscale the North Shore waiting rooms were," Conti said. "The whole experience was calming."

While nobody wants to go to the emergency department, North Shore is rethinking its ED's mission and actual methods.

There doctors communicate with wireless devices and use technology in ways unheard of just a few years ago. Visitors to the ED go to private waiting rooms even before they are admitted.

There's free coffee, tea and snacks. Flat screens show sports, news and other programming in waiting rooms. A children's waiting area looks like a typical doctor's office, complete with a cheerful mural. It almost makes you forget you're in the emergency department. And that's the whole idea.

One reason North Shore and other hospitals are rethinking the ED is that it's getting much more use. Emergency department visits reached 119.2 million in 2006, up 3.48 percent from 115 million in 2005. That translates into 227 visits per minute or nearly four per second, according to a report by the Centers for Disease Control and Prevention.

The North Shore emergency department sees nearly 74,000 patients a year, which, according to Chairman Dr. Andrew E. Sama, makes it "probably larger than half the hospitals in the country." And it does this with only 50 beds.

Emergency departments have made huge headway in dealing with difficulties, such as language problems. Through something known as a translator phone, doctors can patch patients in immediately to translators, so they can speak to nearly anyone through this third person.

Dr. Robert Bramante, who cares for patients in North Shore University Hospital's emergency department, recently faced a communications challenge: a Chinese patient who spoke no English.

Unphased, he carried on a conversation with him in Cantonese through the translator phone, finding out the man and his brother had been burned by a boiler.

"It helped us to know how it happened, when it happened," Bramante said. "And that we could expect someone else to come in with burns."

A better, more efficient ED isn't only good for patients, but creates a better workplace. Once patients get into the main area of the North Shore ED, they find touch-screen monitors hang in patient rooms, putting data literally at doctors' fingertips. Bramante uses his iPhone to access prescription information online.

The sound of the ED has changed, as well. Shrieking ambulance sirens don't pierce the building at North Shore. Workers carry Vocera wireless devices in breast pockets, which largely replace overhead paging.

While new EDs have cracked the language problem, one thing hasn't changed. Patients can feel like they're waiting forever.

While Conti liked the service and setting, she said she and her mother waited longer at North Shore and other EDs than she'd like. "Considering I told them that I thought my mother was having a heart attack, it did take them a while to get her into the emergency room," she said of North Shore.

EDs like North Shore triage serious cases first, sometimes resulting in longer waits for less severe problems. But North Shore on average appears to process patients more rapidly than many counterparts.

"The average waiting time for treatment is 31 minutes," Sama said. "We measure it, monitor it. It goes up sometimes, down sometimes."

Still, "hurry up and wait" could be the motto even of the modern emergency department.

"There's an overcrowding problem across the country," Dr. Sama said. "It has nothing to do with the emergency department. It has to do with the hospital."

EDs, such the one at North Shore, process patients so quickly that hospitals can't admit them fast enough. Sama said patients wait for inpatient beds on average six to eight hours.

Originally published by Claude Solnik.

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