Hospitals are revamping their emergency rooms to make way for technology, more patients and additional staff.
St. Jude Medical Center in Fullerton is working on plans to expand its 31-bed emergency room as part of a modernization project, said Dr. Daniel Abbott, director of emergency services.
The hospital’s ER is set to grow to as many as 50 beds. The project is scheduled to start in late 2006.
St. Jude’s ER is on track to see some 49,000 patients a year. It has 13 ER-trained doctors, three physician’s assistants who see patients with cold and cough symptoms, about 80 ER nurses and 23 additional staffers, including technicians, phlebotomists who draw blood and handle transfusions, and a social worker.
“We are pretty much a self-contained hospital in and of itself,” Abbott said.
St. Jude’s emergency room is applying for a designation as a “stroke center-receiving center,” Abbott said. If the hospital receives it, he said it would be only the third California hospital to have that designation.
“With that background, our stroke center protocol would call for the patients to be triaged and seen immediately,” Abbott said. “A (computed tomography) brain scan would have to be performed within a 45-minute time. If there’s no bleeding and the patient meets the criteria, the patient would be given a thrombolitic (blood medication)” within three hours.
In terms of medical records, St. Jude’s “essentially paperless,” Abbott said. St. Jude’s ER doctors and staff register patients on computers, where they can check the patient’s past medical history, drug history and other medical records.
“All of the doctors have computers. There are computer stations at all of the bedsides,” Abbott said.
But there’s more work to do. Abbott said St. Jude plans to add a computerized drug order entry system in its ER. The system will allow doctors to check for medication errors, incorrect dosages, drug indication and interactions.
New ER technology down the Santa Ana (I-5) Freeway at UCI Medical Center in Orange is bedside diagnostic ultrasound equipment, said Dr. Mark Langdorf, medical director of the teaching hospital’s emergency medicine department.
Having portable ultrasound machines allows UCI’s emergency room doctors to “see pathology that we used to just guess at,” allowing for more accurate diagnoses, Langdorf said.
“We can have an answer in five minutes that used to take three or four hours to get,” he said.
The hospital has 15 full-time emergency faculty physicians, 18 full-time resident physicians and about 100 nurses, including part-time and per diem personnel. It sees some 47,000 patients a year.
UCI Medical has met the emergency room nursing ratio requirements demanded by a law that Gov. Arnold Schwarzenegger suspended in November (see story, page 25).
“We are already at 4-to-1 in the emergency department,” Langdorf said.
UCI Medical’s ER also got more bed capacity, going from 26 to 36 beds. But Langdorf said that there still are crowding challenges, particularly if the flu season is heavy.
“The hospital is pretty full, so patients are waiting too long,” he said.
Langdorf said that at times the ER may have up to 12 patients who have been admitted to the hospital but haven’t gotten a bed yet. He said the waits could range from four to eight hours after admission.
In terms of ER volume, Langdorf said that it was going up gradually, not explosively.
“The university is getting more successful in attracting patient referrals, so whenever something happens after hours, those patients come to the emergency department,” he said. “Our reputation as a county hospital is really going away.”
UCI Medical Center officials still are a little sensitive about the facility’s past as a county hospital. The university bought the hospital from the county nearly 30 years ago, in 1976.
Two years ago, hospital officials said they would limit the number of patients it sees under the county’s Medical Services for the Indigent program and also threatened to end their contract unless the burden of care was spread more widely among other OC hospitals.
Meanwhile, UCI Med-ical Center has not yet joined the ER electronic medical records movement, though it is working on it, Langdorf said.
“Right now, we’re still doing paper and pen,” he said. “There’s a significant cost to going electronic, and then, of course, the electronic stuff has to talk to the existing computer system.”
That is going to be a challenge, Langdorf said, because UCI’s primary computer system is what he called “an old mainframe.”
Meanwhile, Langdorf said UCI’s emergency room won’t move to its hospital tower that’s being built to comply with earthquake standards.
“That’s why we expanded now into 36 beds,” he said.
UCI Medical Center and other University of California hospitals divvied up some $600 million in state bond funds for earthquake retrofits from a law passed in 1997, three years after the Northridge earthquake severely damaged several hospitals in the Los Angeles area, including UCLA Medical Center.
UCI received $235 million to build an earthquake-safe tower; construction will start later this decade.
“The strings attached to that bond money was that hospitals could use it to replace or enhance functions that were in earthquake-unsafe buildings,” Langdorf said.
UCI’s emergency room doesn’t fall under that category,the portion of the hospital where it sits was built in the 1980s and is earthquake safe. California’s hospital earthquake safety law requires that all acute-care hospitals remain standing within 72 hours of a major temblor.
In Laguna Hills, Saddleback Memorial Medical Center has one of the county’s newer emergency rooms, but it’s making technology additions nevertheless, said Dr. Greg Simsarian, the hospital’s emergency department’s medical director.
“We’ve supplemented the technology we’ve already had,” Simsarian said.
Examples include hooking up laptop computers to allow Saddleback’s ER doctors to register patients bedside and wireless phones for staff to use, he said. Then the hospital added digital radiography.
“It’s a kind of sexy sort of thing because you can pull up these complicated X-ray images, CT scans and MRI images right on the computer screen,” Simsarian said.
The system also allows Saddleback’s emergency medicine physicians to pull up the images on a security-coded, Web-based intranet, whether they are in the hospital or in their off-site offices. The system was introduced in 2000, but he said that the hospital improved it last year.
Saddleback’s 31-bed, 17,000-square-foot ER opened in August 2002, doubling the number of beds it previously had.
Saddleback’s ER saw 32,000 patients last year. It has 15 emergency physicians and 50 registered nurses. Simsarian said the hospital “tries to meet” the nursing ratios spelled out in the California law.
