NEARLY 150 MILLION PATIENTS are being treated in Emergency Rooms (ERs) in U.S. hospitals each year. An increase in patients 85 years old and older is requiring ERs to administer more complex care than in the past, and patient volume is increasing among women and in cities, according to a five-year study by the Agency for Healthcare Research and Quality. COMMERCE asked the following New Jersey hospitals to discuss their Emergency Departments, and the evolution of emergency medicine for doctors, EMTs and patients.
Chilton Medical Center, Atlantic Health System
By Frank Briglia, M.D., MPH, FAAP, Medical Director, Children’s Center
Hospitals can be a little overwhelming for everyone, especially children. That’s why Atlantic Health System introduced an innovative approach to pediatric care at Chilton Medical Center. This one-stop center allows us to continue to offer specialized care for the estimated 13,000children we treat a year close to home. Located within the hospital, the new Children’s Center combines both pediatric emergency services and hospital care in one, family-friendly facility. Our pediatric doctors and nurses can handle all types of childhood emergencies and illnesses, from minor injuries to more serious medical conditions that require an overnight stay. And, as the only Atlantic Health System-affiliated hospital in our region, Chilton Medical Center is connected to all the resources and advanced care, including access to more than 100 pediatric specialists, at Goryeb Children’s Hospital at Morristown Medical Center. The Children’s Center features 11 state-of-the-art private rooms, equipped with comfortable, homelike furnishings, including rooms with built-in sleeping accommodations for parents, skylights and gaming systems. And because our team of expertly trained doctors and nurses are all located within the center and solely devoted to pediatric patients, care is delivered seamlessly and efficiently, so children and their families can get back home, where they belong.
Christ Hospital, CarePoint Health
By Tucker Woods, M.D.,Chief Medical Officer,Senior Administrative Officer
Encompassing three hospitals in Hudson County, New Jersey, Care Point Health has recognized the importance of reliable and efficient Emergency Care for our patients, for which new technologies have become game-changers. Recognizing Emergency Room visits are often unexpected and stressful encounters, the need to extend expert medical care beyond the initial ER visit is vital to outcomes, patient satisfaction and cost savings. Hence, we developed “Care Point Connect,” which is a technology-driven platform that can help bridge patients to the next step in their care cycle. When a patient is discharged from the Emergency Room, they are provided the opportunity to have a “video-visit” with an emergency clinician several days after their ER visit. This helps assure the patient is improving, test results are discussed, questions answered, new tests or medications can be prescribed and a warm hand-off to a physician can be arranged real-time. Care Point is currently the only healthcare system in the Metro New York area using telemedicine in this post-acute care environment, and we’ve found improved patient satisfaction, outcomes, and patient retention. Patients can now have confidence their ER visit becomes a convenient way-point in their care cycle, and that the expertise of our ER doctors doesn’t end at the door.
Community Medical Center, RWJBarnabas Health
By William C. Dalsey, M.D.,MBA, FACEP, Chair, Emergency Medicine
The Emergency Department (ED) at Community Medical Center maintains a focus on providing high-quality care by providing patients exceptional emergency medicine specialists, the latest technology and new processes to create efficiencies. To meet the specific needs of various groups within our community, we offer special areas, staff and programs. In addition to a dedicated 24/7pediatric ED with pediatric specialists, the department is autism friendly with specially trained staff and comfort items including iPads with special software. Ocean County is home to the largest population of seniors in New Jersey, and the staff is dedicated to meeting the needs of this vulnerable population. The 21-bed Rapid Diagnostic Unit provides longer-term care for patients in need of further evaluation and treatment prior to a decision to admit or discharge the patient. Dedicated space for psychiatric patients ensures they are safe and cared for by mental health professionals, while patients grappling with opiate-related problems have access to special programs and recovery specialists to help them receive appropriate treatment. The hospital will be investing $23 million in the ED, which will create greater opportunities to improve patient throughput and create greater efficiencies in the department, resulting in a better patient experience.
Englewood Hospital and Medical Center
By Hillary Cohen, M.D.,MPH, Vice President of Medical Affairs, Chief of Emergency Medicine
Visits to the emergency department typically involve an urgency to diagnose, though clinicians are often presented with limited background information about the patient in front of them. Our hospital recently implemented Epic, a leading electronic health record system. This system includes an application called Care Everywhere, which gives our emergency staff access to critical patient information, including known allergies, current medications, existing medical conditions and prior immunizations, from their local Epic records held by other institutions across the country. Whether patients are away from home visiting family, enjoying vacation time or find themselves in an emergency department outside their local area, their providers can share records and access medical history to immediately focus on delivering the proper treatment, and consult with other physicians who have been overseeing their care. As of April 2018, Englewood Hospital had pulled records from more than 100 other hospitals, from as far away as Hawaii, related to patients’ care. Care Everywhere creates a more comprehensive patient history, better informing care and ensuring an integrated experience for medical professionals and those in their care. Information added to patients’ records can also be shared back to their local providers.
Hackensack University Medical Center, Hackensack Meridian Health
By Kevin Hewitt, M.D., Acting Chair, Department of Emergency Medicine
Hackensack University Medical Center is one of only 10 state-designated trauma centers and the only Level-II Trauma Center in Bergen County. Every year, Hackensack University Medical Center treats more than 120,000 patients in its Emergency and Trauma Center (ETC), one of the busiest in New Jersey. Hackensack University Medical Center recently completed construction on its multi-phase ETC expansion and renovation project, creating a state-of-the-art facility to provide patients and their families with care, comfort and privacy. The ETC features 63private patient rooms with sliding glass doors and five trauma bays with a CT scan located within the Shock Trauma area. The ETC also provides specialty treatment areas for cardiac, cancer, geriatric, trauma and pediatric patients. The Pediatric Emergency Department features 17 private patient rooms and is staffed by team members who have earned pediatric specialty certifications. The ETC routinely receives patients transported by Hackensack Meridian Health’s helicopter, Air Med One, which provides emergency air medical lifesaving transportation of critically ill patients who have suffered trauma, stroke and cardiac events. Hackensack University Medical Center’s ETC has the largest emergency medicine residency training program in the state, with 36 residents who learn from our team of emergency physicians and Magnet-designated registered nurses.
Holy Name Medical Center
By Randy Tartacoff, M.D.,FACEP, Co-Director of Emergency Medicine
Holy Name Medical Center’s Emergency Care Center is equipped to handle life-threatening conditions, as well as less serious injuries and illnesses in a timely, compassionate, and culturally sensitive manner. The Emergency Department is focused on getting patients to medical providers rapidly. Pediatric, Fast Track, and geriatric-friendly treatment areas focus on the special needs of children, older adults and patients with minor illnesses and injuries. As a certified Joint Commission Primary Stroke Center, with Gold Plus designation from the American Heart Association and American Stroke Association, Holy Name follows strict protocols for delivering immediate emergency care to every patient with stroke symptoms, with a goal toward preserving vital functions. Patients are evaluated at the bedside and moved seamlessly through diagnostic imaging with a CT scan and other tests. “Time is brain,” with the life of millions of brain cells at stake. At Holy Name, 99percent of our stroke patients receive treatment within a one-hour time frame, most within 30 minutes. Our highly trained stroke specialists deliver clot-busting medications for appropriate patients, which research shows improves, and often restores function. Non-surgical procedures to remove stroke-causing blockages in the brain are performed in Holy Name’s on-site Interventional Institute by highly skilled interventional radiologists and neuroradiologists.
JFK Medical Center,Hackensack Meridian Health
By Samuel LaCapra, M.D.,FACEP, Chairman and Medical Director of Emergency Services
Our state-of-the-art Emergency Department (ED), which serves the residents of Central New Jersey, recently instituted a split-flow triage model to improve the delivery of care. With more than 76,000 visits in 2017, our dedicated clinical team members treated critically ill or injured patients, as well as those with less serious conditions. JFK’s ED remains on the forefront of innovative emergency medicine, performing an essential role in maintaining the advanced diagnostic and treatment standards required of an accredited Chest Pain Center and Advanced Comprehensive Stroke Center. Our private patient bays are equipped with walls and glass doors for privacy, safety and comfort and the ED has bedside registration, an on-site laboratory, radiology department, treatment rooms for minor cases and dedicated parking for patients. Following a trend toward specialized care for pediatric patients, the Pediatric ED has a separate entrance whereby children are protected from adult healthcare emergencies that might be upsetting. Our youngest patients receive expert care in a child-friendly atmosphere, complete with toys, games and other amenities. Our Satellite Emergency Department (SED) in Plainfield logged more than16,000 visits in 2017 and remains one of the busiest SEDs in the state.
St. Joseph’s Health
By Mark Rosenberg, D.O., Chairman, Emergency Medicine
The Emergency Department at St. Joseph’s University Medical Center—the busiest ED in New Jersey—is an innovator in Emergency Medicine, with programs such as the first Geriatric Emergency Department in the United States, the first ED-based Palliative Care Program (Life Sustaining Management and Alternatives) in the country, and the nationally acclaimed Alternatives to Opioids (ALTO®) program. Our Geriatric ED is designed especially for patients 65 years of age and older. St. Joseph’s University Medical Center is the first hospital in the region to provide a dedicated ED for older patients, featuring a 20-bed treatment area with thicker mattresses, natural lighting throughout common areas and reduced noise. In addition, the Pediatric Emergency area has an annual patient volume of more than 40,000 visits, and is staffed by specialists, dually trained in General Pediatrics and Pediatric Emergency Medicine. To take action against the growing opioid epidemic, we developed an innovative program that gives providers options they can use to effectively alleviate pain, without resorting to highly addictive medication. The ALTO® program uses targeted non-opioid medications to address patients’ pain management needs and avoid opioids in cases of kidney stones, acute low back pain, broken bones, acute headache, migraine pain, etc.
The Valley Hospital
By George Becker, M.D., Director, Emergency Department
We are actively planning and designing a state-of-the-art Emergency Department (ED) for The “New” Valley Hospital. We currently offer specialized emergency care for children and we will be working towards specialized Geriatric ED certification this year. We use the latest diagnostic technology and are a state-designated Comprehensive Stroke Center and Percutaneous Coronary Intervention-Cardiac Surgery Center for myocardial infarction. We utilize the Twiage app to enable first responders to pre-notify the ED about incoming patients. In addition, patients are able to schedule their ED appointments online using the InQuicker tool. We are researching using telemedicine to further expedite both the triage process and patient workups. We incorporate palliative care into our practice and employ case managers to ensure streamlined care. We are working with the Transitional Care Program to facilitate a patient’s ED arrival and post-ED treatment throughout the continuum of care. We are investigating using EDIE (ED Information Exchange) as part of a New Jersey Hospital Association initiative to identify patients with complex medical and social issues that lead to multiple ED visits at multiple institutions.
Trinitas Regional Medical Center
By John D’Angelo, D.O., Chairman of Emergency Medicine
Since the completion of the $18.7 million renovation and expansion of our Emergency Department last year, we have increased space, improved technology and separated treatment areas to enable faster and higher-quality emergency care. We now have 24,000 square feet and have gone from 27 to 45 treatment beds. The expanded “fast track” area is for minor emergencies and we have separate areas for seniors, families and behavioral health patients. With these improvements, patients will experience more personalized care tailored to their needs. Three new Intensive Care Unit rooms, which were also part of the renovation, now allow patients to be treated quickly in the ER without having to wait for a bed in the hospital to become available if they need to be admitted. We now have a 128-slice CT scanner that produces diagnostic scans in seconds right in the ER, so patients don’t have to travel to the Radiology Department for a CT or ultrasound scan. In general, care is not only more efficient, but also much more personal.