Emergency Department for the Future by nih35233


									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
                                                                                                                          UNITED HOSPITAL

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.

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

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
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

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.

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