No Wait at the ER

Many hospitals are working hard to keep it short

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Clear communication is a key customer service goal, too. "Our challenge is to continually update the patient so that at the end of the visit, she doesn't feel she's been stuck in a corner. And we've got to teach this kind of language to residents, nurses, technicians, and everyone else involved," says Peter Hill, associate professor of emergency medicine and vice chair of clinical affairs at Johns Hopkins Hospital in Baltimore. Hopkins's new emergency department has only private rooms, each with a PC, allowing doctors to more easily document and share information with patients.

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Prompt briefing. "When I've had to deal with other emergency situations, I had to find out who was in charge and whether that person was available to talk to me. Here, they came to find me," says Ishmael Rivera, a retired New York City firefighter whose son Jeremy recently tore open his shin to the bone in a fall at school and was taken to New York-Presbyterian's Morgan Stanley Children's Hospital. When Dad rushed in, staffers were waiting to tell him what the damage was, who was treating Jeremy, and what needed to be done—and they had the boy smiling and chattering. "I loved that they were playing with him, that they liked him and he liked them, and that the doctors were quick, aggressive, and top-notch," Rivera says. "And I was surprised they engaged in so much conversation with us."

A huge part of perfecting emergency care, of course, involves coordinating rapidly and seamlessly with other hospital departments. It was that sort of "quick action" that saved her, says Joan Hampton of Charlotte, N.C., who suffered a severe stroke a year ago at age 45 and was taken by ambulance to Carolinas Medical Center. An emergency team immediately assessed her situation and paged the hospital's stroke team. The team, including an emergency physician, stroke neurologist, radiologist, nurses, and lab technicians, rushed to the ED and evaluated her, and stroke neurologist Phaniraj Iyengar called for a dose of the clotbuster tPA. The drug, effective only if administered within a few hours of a stroke, opened the blockage completely, and Hampton went home in three days with virtually no damage. At the Mayo Clinic, mandatory monthly training puts multi­disciplinary trauma team members from around the hospital through their paces using simulations; each member learns to perform assigned roles, to communicate in a common language, to listen, and to resolve conflict on the spot.

"The potential for disorganization would have been great had we not practiced," says Beth Ballinger, an acute care trauma surgeon at Mayo, recalling a day three years ago, shortly after the training started, when teenage twins were brought in near death after a car accident—a horrible head-on collision with each other. The team, which Ballinger oversaw, included ED attending physician Annie Sadosty, nurses, a respiratory therapist, resident physicians, a pharmacist, and others, and "worked like a finely tuned orchestra," Sadosty says. The team resuscitated and stabilized both twins.