COMPILED BY MILES Z. EPSTEIN, EDITOR, COMMERCE
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 and patients.
Atlantic Health System, Morristown Medical Center By Dan Wiener, M.D., Chairman, Department of Emergency Medicine
We are seeing an increase in the number of patients coming to the ED, and the patients we are treating are very ill. The number of low acuity patients is only about 10 percent of our volume. We attribute this increase to our reputation, not a lack of access to care. Morristown Medical Center has specialized emergency departments for both pediatric patients as well as the geriatric population. We recently earned Level 2 (silver) Geriatric Emer-gency Department Accreditation from The American College of Emergency Physicians. Both specialized emergency departments have accommodations appropriate to the patient population (autism-friendly rooms, bright colors for the children and amenities like non-skid flooring and access to canes and walkers for the geriatric population), as well as multi-specialty teams. All Atlantic Health System hospitals recently went live on the Epic Electronic Health Record system, which has allowed us to best coordinate care across sites. We continue to find ways to treat patients faster: We implemented RAPID software (most advanced visualization software for the brain) that analyzes CT and MRI scans of acute stroke patients to optimize them for thrombectomy; and ambulances transmit results of EKGs from the vehicle, allowing our team to expedite door-to-balloon time. Stroke patients have a virtual consult with a neurologist in the field via video, which has improved our TPA administration times.
Englewood Health By Hillary Cohen, M.D., Chief of Emergency Medicine and VP of Medical Affairs
The emergency department at Englewood Health employs a highly trained medical staff and has cutting-edge equipment, but what about patients with needs extending beyond medical care? In 2016, Englewood Health participated in a Community Health Needs Assessment, which ranked mental health and addiction as top concerns. We’ve since increased investment in behavioral health resources both in the emergency department for acute care, and outpatient services including opening The Gregory P. Shadek Behavioral Care Center, with a focus on prevention and education. Through this new center, additional social workers were added to the emergency department to focus on patients with behavioral health needs, such as acute psychosis, suicide attempts or substance use disorders. Since the implementation of the social work services, patients and families experiencing a behavioral health crisis have been provided better support. Additionally, length of stay for psychiatric patients has been reduced and linkages to outpatient care have significantly improved. We are also focusing on patients with multiple emergency department visits per month through coordinated care across various departments in the hospital and developing long-term care plans for managing the patient’s care.
Holy Name Medical Center By Tae Keun Park, M.D., Co-Medical Director, Emergency Medicine Dept.
As the population in northern New Jersey ages, the highly skilled, board-certified medical and nursing team of Holy Name Medical Center’s Emergency Care Center is caring for more patients who are older and sicker. This requires keeping up to date on the latest generation technology and new techniques for delivering emergency care for cardiac issues, respiratory distress, diabetic emergencies, stroke, and other life-threatening medical situations, as well as mental health emergencies. When every second counts, our Primary Stroke Center’s “telestroke” technology has reduced vital door-to-needle treatment time from an average of 60 minutes to 45 minutes. Our 24/7/365 interventional cardiology teams perform life-saving cardiac angioplasty and stenting within the gold standard door-to-balloon time of one hour. Board-certified OB/GYNs and pediatricians are in the medical center around the clock to assist with obstetrical and pediatric emergencies. Case managers and social workers are available to coordinate inpatient transfers to nursing units, transitional care, home care nursing and physical therapy, and post-acute and long-term care facilities for geriatric patients. Holy Name’s fleet of paramedics and emergency medical technicians are experienced in performing in-the-field advanced clinical life support, pre-hospital trauma support, treatment for severe allergies and drug overdoses, incident command, and HAZMAT response.
Hudson Regional Hospital By Alexander Sarenac, M.D., Medical Director, Emergency Department
Our full-service Emergency Department can care for medical emergencies 24/7 with the latest technologies available, including ultrasound, CAT Scan and MRI, and an extensive network of specialists available on call. We use technology and telemedicine to provide immediate, bedside evaluation in critical, time-dependent emergencies such as strokes and other neurological emergencies, and Glidescope allows doctors to provide the best possible visualization in airway emergencies. We are currently undergoing a complete renovation of our Emergency Room in response to trends in providing age-specific care for our youngest and oldest patients, and concierge-style customer service with a Patient Liaison team to update patients and their families about delays, aid in comfort measures and help make the entire visit more informative and comfortable. The Emergency Room renovation will provide all private rooms to our patients, with some rooms designed to care for the specific needs of pediatric and geriatric patients. Pediatric patients can be seen by an on-site pediatrician on a dedicated pediatric floor, and the Geriatric Care Room will have reduced exposure to lights and sounds providing a reassuring and calm environment for older patients.
Jefferson Health–New Jersey By Henry Schuitmena, D.O., FACOEP, Chief, Department of Emergency Medicine
We have three hospital-based Emergency Departments at Jefferson Health in New Jersey. The major changes we’ve seen are related to advances in Stroke Care; two of our EDs are state-designated Primary Stroke Centers and one is a Comprehensive Stroke Center. To achieve and maintain these designations, we have to meet certain standards of excellence in stroke care, including the timely use of clot-busting medications and mobilization of interventionalists. We also are very proactively responding to the opioid crisis by providing on-site recovery coaches in our Jefferson EDs. We strive to be highly responsive to the ever-changing needs of the communities we serve.
JFK Medical Center Hackensack Meridian Health By Frank Cunningham, M.D., FAAP, FACEP, Medical Director, Pediatric Emergency Medicine
Children aren’t little grown-ups—they have different needs, both medically and developmentally. Our Pediatric Emergency Department (PED) provides state-of-the-art pediatric emergency care in a separate designated area, designed especially for children. The PED is comprised of 15 private exam rooms, including a separate triage room to reduce wait times and enhance patient privacy. With more than 17,000 patients annually, the PED is staffed 24/7 with board-certified pediatricians and pediatric emergency specialized nurses. Our PED has been involved in collaborative multidisciplinary efforts in developing clinical pathways to standardize and improve the approach to the evaluation of head injury and abdominal pain, thereby reducing radiation exposure. We are integrally involved with the Department of Pediatrics, Antibiotic Stewardship program reducing unnecessary antibiotic usage and, when needed, choosing the correct antibiotics for the appropriate diagnosis. Children and their families look for practitioners who are trained in recognizing these specific differences and delivering a more soothing approach to ease what can be perceived as a frightening experience. Our physicians, nurses, and support staff are trained to provide high-quality, safe, and compassionate care and to help make the hectic environment of the PED be as comfortable an experience as possible.
St. Joseph’s Health, St. Joseph’s University Medical Center By Marianna Karounos, D.O., M.S., FACEP, Chief of Emergency Medicine
The overall aging of the United States and the unprecedented growth of the 65 years and older age group have created a unique need for specialized Geriatric Emergency Medicine. Older adults use seven times more Emergency Department services than other age cohorts, account for approximately 43 percent of inpatient admissions, have 20 percent longer lengths of stay and require 400 percent more social service interventions during the course of their hospitalization. With the current population of older adults at an estimated 39 million, a shift in our approach to care has become essential. To improve care for older adults, St. Joseph’s Health created the region’s first Geriatric Emergency Department (GED). This innovative solution provides our patients with a unique experience in a specialized environment of care, where older adults can have an optimized emergency visit. We utilize skilled Geriatric Nurse Navigators that work alongside the clinical team to screen for safety and self-care at home, delirium and malnutrition. We also assess the risk for falling and depression and coordinate necessary services upon discharge. The specialized team provides individualized treatment and care coordination to enhance patient experience and overall outcome.
The Valley Hospital By George Becker, M.D., Director, Emergency Department (ED)
We are actively planning and designing a state-of-the-art ED for The “New” Valley Hospital. We offer a specialized emergency department for children and are pleased to have received Geriatric Accreditation by the American College of Emergency Physicians. This accreditation reflects the strong emphasis our ED staff places in serving the needs of our senior population with optimal care and support. 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. 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 work 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.