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More Space For Changing Needs Of Emergency Department At St. Francis

Hospital's new emergency department opens next month

William Weir

March 20, 2011

Betsy Weinbach, an emergency department nurse at St. Francis Hospital and Medical Center, recalls an especially hectic shift on a recent Monday.

"A couple of weeks ago, we had over 100 patients in the department," she said. "We had patients placed sideways just to accommodate new patients coming in."

As they were put in hallways and shuffled around to make room for new arrivals, the patients became increasingly frustrated, as did their families and staff. Under current conditions, there's not much way around it.

"You just do the best you can and prioritize," she said. "And apologize."

But the cramped environment will change in mid-April when the hospital opens its new emergency department, a crucial part of the new 10-story tower that St. Francis is opening in stages. The Connecticut Joint Replacement Institute on the tower's fourth floor opened last week, and 17 new operating rooms will open on April 4. Hospital officials expect the $184 million John T. O'Connell Tower to be fully in operation by early June.

The new emergency department will open April 13 early in the morning, and for a few hours both the current and new departments will be staffed and operating. Hospital officials are taking pains to get out the word that the entrance for the emergency department will move from Woodland Street to Ashley Street.

For emergency department workers, the new facility can't come soon enough. The kind of overflow that Weinbach described has become common in recent years, especially in the winter and on Mondays — because many people hold off going to the doctor over the weekend.

The current department is designed for an annual capacity of about 50,000 visits a year. In 2002, it had more than 58,000 visitors. Last year, nearly 72,000 patients passed through the department.

Dr. C. Steven Wolf, chairman and director of the hospital's department of emergency medicine, said that the steady increase in visits is due partly to advances in health care.

People are "living longer, but as a result they're going to the emergency department more," he said. "It's a different, sicker population."

In addition, Wolf said, while a personal physician once might have told a patient complaining of heart pain to come in to the office for a visit, now that patient is referred to the emergency room, which has all the equipment necessary to determine the seriousness of a heart patient's situation.

The new emergency department has 70 beds — up from 48 in the existing ER — and double the floor space at 48,000 square feet. Rooms are private, rather than separated by curtains, and larger than rooms in the existing emergency room. They also are equipped with smart beds — which can weigh the patient and provide other monitoring — and a lift system that makes it easier for a nurse to move a patient.

The number of trauma patients who can be treated at one time will increase from two to eight. A new helipad for Life Star is at the top of the tower — a straight shot down the elevator to the emergency department.

The new department has a projected annual capacity of 90,000 to 100,000 visits. The hospital hasn't approached that level yet, but Wolf said it might not be long before it does, especially as the baby boom generation gets older.

Dr. Perry Dansky, an emergency physician who has been at St. Francis for 15 years, said the basic operations of the department haven't changed, even as space has become increasingly scarce. "The most important element is identifying who's the sickest, who needs care first, and we're still applying that triage concept," Dansky said.

But when there's a crush of patients, that adds tension to a situation that already is fraught with it.

"It's uncomfortable for families and the patients; no one wants to be in the hallway. Patients are scared, ill, emotionally they're challenged, and their space is being invaded," Dansky said.

Even more than the additional space, Dansky is looking forward to a more efficient flow in the department. "We'll have the opportunity to get people into the system faster," he said. That means getting them treated more quickly, and ideally, home sooner.

"We've got computers in every room so that we can literally put in all their orders by the bedside," Dansky said. As it is now, doctors write on their clipboards and then go to one of the computer stations to enter their notes digitally. The computers might not seem like a dramatic change, but anything that improves the flow — even by a few minutes — is crucial to emergency work.

The new department also has a 10-bay medical express treatment area for patients with less acute emergencies.

Weinbach said she's looking forward to having CT scans and X-ray machines nearby. She now has to go to a different floor to use that equipment, and that means having to get another nurse to cover for her for 15 to 20 minutes. On a busy night, those minutes add up.

Emergency medical services also play a big role in providing emergency care efficiently, and the new dropoff point for ambulances is expected to be a great improvement.

The current drop-off area has six parking spots, "but we often have 10 or 12 ambulances at a time, so patients are dropped off at the street," said John Quinlavin, the hospital's EMS coordinator. And it only takes two ambulances parked side by side to block all the others from passing, which requires tracking down drivers to move their vehicles.

The new drop-off point has 13 covered spaces designed for angled parking to prevent blocking.

There's also parking available right outside the new emergency department for walk-in patients; at present, people have to cross Woodland to get to the emergency department.

Once inside, EMS workers will have their own work station with computers so they can file their reports easily. Their work station also has coffee machines, food and a refrigerator — a big plus for people working shifts 12 hours and longer.

"That was well thought out," Dansky said. "You want them to feel that they're a part of it."

Overall, Dansky said, the new emergency department is a big plus for the hospital.

"Fifty percent of the people admitted [to St. Francis] come here through this department, so this is their first impression."