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A Model of Its Kind
Howard County’s Pediatric Emergency Department is setting patient satisfaction records

The Peds ED Team: Back row, from left, Diane Emrich, R.N.; Sherri Dougherty, secretary; David Monroe, M.D.; Kiernan DeAngelis, M.D.; Eugene Macaraeg, patient care tech. Front row, Larissa Collins, R.N., Lauri Martin, R. N., Myrna Arao, R.N.
Early on the morning of June 1, a school bus in Howard County ran off the road and turned over, injuring more than a dozen children. When the call came in to the Pediatric ED at Howard County General Hospital, the attending physician and nurse manager decided to take all the patients. “I knew my experienced staff could handle the situation,” recalls the nurse, Diane Emrich, clinical program manager for pediatrics.

She was right. The children, 16 in all, arrived at around 9:30 that morning. One by one, they were assessed and treated, most for bruises and superficial injuries. It went like clockwork. By noon, all had been released.

That kind of smooth service is part of what’s driving the Peds ED’s remarkable patient satisfaction ratings. Quarterly surveys sent to random patients attract rave reviews (“Excellent! Never had a better emergency room experience.” “May I always be so lucky!”). For the past two years, the department has ranked consistently in the 75th percentile, scoring between 84.2 and 85.3 on a scale of 100. For the quarter ending Sept. 30, it scored its highest satisfaction rating ever, coming in above the 95th national percentile ranking.

What’s the secret behind these soaring satisfaction rates? Vic Broccolino, president and CEO of the 182-bed community hospital, says it’s the “can-do” attitude on the part of the entire team. “Most live in the community. They are treating the children of their neighbors or colleagues.”

Myrna Arao with a patient and her mother.

Patients’ tributes extend to everyone on the team. That includes the physicians, most of whom practice exclusively at HCGH; the 36 nurses (approximately 16 FTEs), all trained in pediatrics; patient support techs and housekeeping personnel. “They are always on the unit looking to see what needs to be done,” medical director David Monroe says of the environmental services team. “There’s a sense of ownership. This is their unit.”

The environment has likewise contributed to patient satisfaction. Situated in a two-story, $31.5 million addition that opened in 2002—the largest construction project in the hospital’s history—the department is separate from, but adjacent to, adult emergency services. Its 12 ER rooms are on one side of the unit, its six private inpatient rooms on the other. These areas are divided by an elongated, central nursing station. “Kids who are admitted see the same nurses and doctors. They get continuity,” says Debbie Fleischmann, director of nursing for pediatrics, ED and short stay. “We don’t know of anyone else in the mid-Atlantic area who had come up with this concept.” Other area community hospitals took note, however, and some have since patterned their pediatric emergency rooms on Howard County General’s.

The combined model was actually created to achieve efficient nursing practice. Community hospitals nationwide have had to downsize their pediatric inpatient units significantly and send the nurses off to other units, according to Fleischmann. But when inpatient beds are vacant in the Peds ED at HCGH, nurses can work in the adjacent intensive setting. (Only about 4 percent of ED patients are admitted, and the average length of stay is 1.5 days.)

Before the addition was built, the service was in a three-bed area, and it was growing at a rate of 30 percent a year. “Wait time became an issue because we did not have the capacity,” says Fleischmann. The new wing tripled the department’s space and slashed wait times to less than two hours, on average. Volumes, meanwhile, exploded from about 6,000 visits a year in 1996 to 19,000 last year.

Nurse Lauri Martin, right, with a tiny patient and his mother.

Inpatient rooms have also served the community well. “Previously,” says Monroe, “children with conditions like asthma and appendicitis who had to stay overnight in a hospital had to travel to Baltimore or Washington. Now children with these common pediatric illnesses can stay right in their own community.” The department works closely with Johns Hopkins’ pediatric specialists and subspecialists, Monroe adds, and sends patients (five per week, on average) to the Children’s Center at Hopkins Hospital exclusively.

Monroe and his team are constantly tweaking the service. A patient safety program focusing on patient identification and medication safety was recently implemented. X-rays are now available in minutes. Wait times may be further reduced by dedicating some rooms to quicker patients. There are even plans in the works to take appointments. “Conceptually, it’s a leap,” Monroe allows. But often, he says, kids would be more comfortable waiting at home, rather than in the emergency department.

“We had the highest satisfaction ratings ever this quarter, but we’re not stopping there,” says Monroe. “We’re always trying to find out what makes patients happy.”

—Anne Bennett Swingle

Lian Mei Xu, left, and Mark Jobe, of environmental services, in the library. Medical director David Monroe checks a young patient. Diane Emrich confers with Kiernan DeAngelis.




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