"Emergency Department for the Future"
Emergency Department for the Future United Hospital Foundation Campaign “Serving as a front door to our communities” As the ﬂagship hospital for the Twin Cities East Metro area, United Hospital faces constant, daily pressure to provide effective, fast and affordable treatment to the members of the community. As the main entry point for many who need emergent and urgent health care, the Emergency Department responds to this duty 24/7. Today, the most pressing need in health care is improved emergency care. Emergency departments across the coun- try see more than 100 million patient visits each year, and this number is expected to grow as our population con- tinues to age and health care costs continue to rise. More than half of these emergency department patients are admitted to the hospital; at United the ﬁgure is more than 40 percent. What was once the back door to the hospital has truly become the front door for health care access. United’s Emergency Department is recognized as one of the busiest emergency departments in the Twin Cities, serving more than 40,000 people annually. As one of the ﬁrst hospitals in the Twin Cities to be exclusively staffed by full-time, board-certiﬁed emergency department physicians, United provides 24-hour emergency care through ﬁve trauma stabiliza- tion rooms and 13 emergency treatment areas. In addition, United Hospital is a referral center for hospitals and clinics throughout the East Metro, the outer suburbs and Western Wisconsin. Likewise, it is a haven, one of the few in the metro area for adults and adolescents with serious mental illness. As the doorway to the community, United’s Emergency Department responds to life-threatening injuries and illness rang- ing from heart attacks to stroke. But, the Emergency Department must also be prepared for the very real possibilities of terrorist threats, large-scale natural disasters and worldwide epidemics. As such, the Emergency Department is the front- line for a community’s defense. We MUST be prepared to handle any and all risks in a ﬂexible and scalable fashion. Challenges facing our community that affect emergency care include increasing numbers of patients: • who have no access to medical care or health insurance. • who use the Emergency Department for primary or urgent care. • with mental health problems. • who have complex health problems due to increased aging UNITED HOSPITAL FOUNDATION UNITED HOSPITAL FOUNDATION TO MEET OUR GROWING NEED Our mission is to serve our communities by providing exceptional care, as we prevent illness, restore health and provide com- fort to all who entrust us with their care. But living up to that mission is becoming a greater challenge as the medical needs of our communities continues to grow and change. United’s Emergency Department, last remodeled in 1997, is too small for the number of patients being seen. According to nationally recognized design standards, our 18-bed department should have 25 to 33 beds just to meet the current patient volume. Many similar-sized facilities that see the same number of patients as United also have ancillary units, such as fast- track beds and short-term observation or critical decision units for the rapid assessment and intermediate treatment. To meet our growing needs, the Emergency Department at United would bring together a wide range of specialists who provide coordinated, comprehensive care to our patients. Because emergency medicine is rapidly evolving, new techniques, procedures, protocols and medical devices are easier to afford when they are shared by members of a large integrated depart- ment. Patients’, payers’ and employees’ demand for state-of-the-art treatment and services can be provided more efﬁciently and affordability with a comprehensive and uniﬁed department. United Hospital’s Emergency Department plans to bring all of its programs, disaster preparedness, advanced technology and community education efforts together under one umbrella. This new department will meet the needs of our community with cost-effective, disaster ready, state-of-the-art resources that otherwise will be unavailable in our community. The Need for a New Emergency Department United Hospital has the rare opportunity to redeﬁne and change the way emergency care is delivered to the community. Emergency departments are the front door to most American hospitals, supporting more than 100 million visits each year. More than half of these visits lead to hospital, thus supporting the need for a full-service department that can ensure manage- able patient ﬂow into the hospital. As the largest tertiary hospital in the East Metro and Western Wisconsin, United Hospital is seeing a dramatic increase in the number of cases coming through its Emergency Department doors. The current design of United’s Emergency Department has unfortunate physical limitations that signiﬁcantly impair staff interaction and productivity. United needs a department speciﬁ- cally designed to manage biologic, chemical and mass casualty incidents. As the largest facility in the East Metro, United is considered one of the ﬁrst hospitals for emergency crews to rely on in disasters. If we do not address the current structure of our Emergency Department, we may ultimately compromise the quality of care we provide our patients and contribute to the rising costs of health care. THE CHALLENGES FACING OUR COMMUNITY Emergency departments across the country are the ﬁrst line for many patients who have no access to medical care or health insurance. The routine provision of simple medical care to the often forgotten and forlorn is, perhaps, the most salient feature of emergency care. Under federal law, no patient may be refused care at any emergency department. While the use of emergency departments for primary care has occurred for many years, most hospitals have seen a dramatic increase in this utilization over the past decade. We’ve also seen an increase in the number of patients with mental health issues. As government subsidies for mental health and substance abuse began to evaporate, these vulnerable people were shunted to the Emergency Department. A shortage of inpatient psychiatric beds, outpatient treatment options and detoxiﬁcation and substance abuse treatment centers has further increased the number of mental health patients seen at Emergency Departments. UNITED HOSPITAL FOUNDATION Additional pressures include inadequate numbers of psychiatric practitioners in many emergency departments and the percep- tion that seriously mentally ill patients present a danger to the Emergency Department patients and staff. Psychiatric patients’ need for supervision also affect security. Adding to the burden of patients seen in emergency departments is the aging population. The baby boom generation means more older patients with more successfully managed chronic conditions presenting for complex care. It’s extremely costly to provide primary and nonurgent care that many patients require. Research shows, the best way for United to address the emergency care needs of our community is to integrate all our programs and technology into one area dedicated to the diagnosis, treatment and research of emergency medicine. Disaster/Trauma Planning “DISASTERS USUALLY STRIKE QUICK AND WITHOUT WARNING” In mass medical crises, medical facilities must not only remain functional, they must be “hyper-functional.” Since 9/11 and the SARS crisis, the design features necessary for Emergency Departments to meet this requirement have received signiﬁcant study. This body of design has coalesced around a concept of the “all-risks ready” Emergency Department. The following major areas embody this Emergency Department design concept: • Threat mitigation — the protection of the physical plant, its assets and most important, its occupants. • Medical management — having the correct specialized facilities and other physical assets needed to rapidly and effectively treat patients during a mass medical crisis. • Surge capacity — the ability to treat a far greater number of patients in a given time period than in normal times. • Connectivity — informatics and communication capabilities that are built into systems and facility design. In the new, “all-risks ready” emergency department of the future, these concepts are appropriately incorporated into the initial design process. Each individual hospital must assess its projected operational or clinical needs in ordinary times through rec- ognized functional programming. But, in addition, the “all-risks-ready” concept requires a determination, in conjunction with local and regional authorities, of the facility’s role in a mass crisis. This requires an appropriate threat assessment of the types of medical problems likely to be encountered, types of direct or collateral damage expected to the facility itself and threats to the facility as a result of providing care, e.g., spread of infection or radiation throughout the hospital. A threat analysis to the United Hospital community might include the following: • Signiﬁcant tornado touchdown in a heavily populated metropolitan area • Reﬁnery explosion • “Dirty bomb” terrorist attack at a large, heavily populated facility or region • Arrival of an ill, airline traveler at the airport who requires hospitalization and who subsequently is diagnosed with a communicable disease like SARS, Ebola virus or monkey pox. Once a hospital has performed its threat analysis, it must then recognize its critical axis — those internal areas and infra- structure essential for maintaining effective delivery of care. An “all-risks-ready” facility would be expected to continue to provide medical care consistent with its mission despite any contingency. These areas would generally include the emergency department, which contains a command and control center, central communications and informatics systems, operating suites, intensive care and other specialty care areas, imaging lab and pharmacy capabilities, critical facility resources, such as water, gases, power and ventilation systems. UNITED HOSPITAL FOUNDATION Bioterrorism When it comes to disasters, it’s impossible for anyone to predict what type of event may happen and what the risk will be. But what can be predicted is that the emergency department will be the frontline of defense. We MUST be prepared to handle any and all risks in a ﬂexible and scalable fashion. Unfortunately, emergency departments need to be speciﬁcally designed to manage biologic, chemical and mass casualty inci- dents. Currently, our Emergency Department is equipped to handle simple decontamination and can provide antidotes for small numbers of victims, but NO civilian emergency department has been designed to handle mass victims in any major metropolitan area at high risk. United’s Emergency Department needs to be designed to handle all risks, including the medical consequences of both new and old weapons of mass destruction. Treatment areas need to be designed to prevent cross-infection and cross-contamination. Every room should be an isolation room, with full respiratory isolation, dangerous waste containment, protective equipment and every other technology that will keep patients and employees safe. An Emergency Department the Community Deserves United Hospital needs to be responsible to the communities it serves by becoming a model for the nation on how the next generation of emergency departments should be built and run. To adequately serve our growing populations, we need the ability to expand and contract stafﬁng efﬁciently throughout the day. And we need a ﬂoor plan that is intuitively clear to both staff and patients. To achieve the best outcomes possible in emergency medicine, the United Emergency Department should be proximate to key hospital functions such as the intensive care unit, surgery and radiology. With the threat of bioterrorism, the new Emergency Department must have the ability to handle large numbers of patients on a daily basis and to ramp up for larger numbers in a matter of minutes. Enhanced triage capabilities are critical, allowing us to have rapid intake of entire busloads of patients with little warning. As one of the largest health care providers in Minnesota, United Hospital is privileged to take care of people during a vulnerable time in their life. It’s important to ensure each and every patient that they are getting the best and safest treatment available. This is the ﬁrst step in helping the thousands of people who rely on this hospital for life-saving treatment. After all, it’s our mission to serve our communities by providing exceptional care, as we prevent illness, restore health and provide comfort to all who entrust us with their care. To Donate If you would like to make a donation to the United Hospital Emergency Department Fund, please contact the United Hospital Foundation at 651-241-8022. For more information about United Hospital or the United Hospital Foundation, please visit us at www.unitedhospital.com.