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Emergency Make-Over
At Howard County General Hospital, a jewel of a new facility is bigger, quieter and has the technology to make it more efficient.

During the grand opening, emergency services administrative director Debbie Fleischmann, emergency medicine director Mark King and ED clinical nurse manager Patty Bent show off some of the upgrades.

On the morning of July 2, nurse Patty Bent got to work at 4:30 to start moving her department into its new home, a full three times as large as the old space. As she looked around her 12 hours later, her prediction for that day had come true. Every bed was full.

"Since we've been parking people along the nurse's station for so long, I figured this would happen," said Bent, clinical nurse manager of the Emergency Department at Howard County General Hospital.

Yet everything seemed unusually quiet and organized on that first day, and it seemed hard even for staff to believe that there were patients in all 36 adult beds.

"It's the additional space, the private rooms, being able to spread the work flow out, having the bedside registration up and running," was how Debbie Fleischmann, administrative director of emergency services, explained it. "Everything's working very well, and although we've been extremely busy, it doesn't feel that way."

This was just the kind of effect that all those involved in planning the new emergency department had in mind when they designed the 24,000-square-foot facility, the biggest component of a two-story wing that, at a cost of $31.5 million, is the largest construction project in the hospital's history.

One only need look at the numbers to see why such a building was necessary. In 1990, 24,000 emergency visits were recorded; last year, there were 56,000. The new ED was designed to handle 70,000, although it also can accommodate swells of up to 200 patients a day. Both the county's growth and the closure or restriction of urgent care centers have contributed to the overcrowding, a problem reported in 62 percent of the nation's EDs.

The facility is a beauty. Elongated central nursing stations dominate each of three sections-urgent, acute and pediatric care. Curtained cubicles have been replaced by private rooms throughout, with phones and TV. Each room has a computer, too, on which patients can be registered, tests can be ordered and results read. A telemedicine link with Johns Hopkins will allow Hopkins physicians to electronically review patient tests and images in real time, and to provide feedback to the treating physician.

Some rooms are specially outfitted to treat infections, orthopedic injuries or sexual assault, to name a few. Pediatrics, for the first time, has its own code room. There is even space set aside for emergency medicine technicians and law enforcement to get together to document cases.

One of the most visible upgrades is a computerized patient tracking system, a display board for patient names-a big improvement over the old plastic marker board. As patients travel through the ED, their status is recorded and displayed through a color-coded key. Blue means the doctor's orders are ready to be carried out; purple is a request for a consult; green equals discharge; and yellow signals a patient is being admitted.

More importantly, the system can be used to collect data, particularly on delays in the ED, a subject close to the heart of every hospital administrator across the country. How long did it take staff to carry out orders? How long to get a consultant there? And how long to move a patient to an inpatient floor?

"The overall goal is to decrease the time patients spend in the ED," says Fleischmann. "And the tracking system helps us identify the bottlenecks and delays so we can correct them."

But for now, the Howard County staff is still trying to get used to all the extra elbow room. "The best part has been giving the staff the overall space to do their work," says Fleischmann. "It's just been so needed for such a long time."

-Mary Ellen Miller



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