Emergency: America

US medical student Oveys Mansuri has been fortunate enough to train in a newly refurbished emergency department. So, too, have Nigerian students, Chibuzo Odigwe and Seye Abimbola. Their situations are, however, quite different

Emergency departments in the US face varying newspaper headlines reading "Emergency rooms are seeing more patients than ever before" and "Emergency rooms in the red."

ELAINE THOMPSON/AP

According to the American College of Emergency Physicians, from 1997 to 2002 the number of emergency departments in the United States decreased from 4270 to 4037 while the number of visits increased 17% from 97 million to more than 114 million. Emergency departments in the United States struggle to find a balance between supply, demand, and financial viability, as they also realise their new role as the primary access to health care for millions of Americans. Some hospitals have taken the approach of building new emergency departments that take advantage of the latest technology and use their past experiences as guides to future planning.

Advocate Lutheran General Hospital is one such hospital. It is a 609 bed teaching, research, and tertiary care hospital, level I trauma centre, with a dedicated comprehensive children's hospital. It is one of the largest hospitals in the Chicago area, and has been ranked as among the top 10 hospitals in the nation for quality of care. The emergency department, which treats more than 52 000 patients each year, is responsible for about 57% of the hospital's total admissions.

The department underwent a complete renovation one year ago and now maintains one of the newest emergency departments in the Chicago area. According to Douglas Propp, chair of the department of emergency medicine, some of the reasons for building a new emergency department included outdated space and amenities, infrastructure, and providing a comfortable experience for patients and families. The process involved almost three years of evaluating the current system, formulating a business plan, and developing funding opportunities and a working budget.

The new department is twice the size, with a new waiting room designed to dually tackle triage functionality and provide a comfortable and private space for families of patients. The layout of the department divides the room into four different teams, including a paediatric suite that can adjust physical space and physician coverage by the time of day and patient volume, increasing staff efficiency. The new department offers 31 private rooms including three trauma rooms.

Modern amenities include a satellite laboratory in the department that operates from 10 am to 10 pm reducing transit time. Given the increased use of imaging to help in diagnosis, a high speed 16 slice computed tomography scanner and radiology suite located in the emergency services area complemented by 24 hour radiology attending coverage was introduced to facilitate radiological studies. Dictations of readings are instantaneously accessible by telephone via a rapid telephone access system reducing waiting times for "wet reads" of imagings.

In the next few months the emergency department will officially have picture archiving and communication systems to allow emergency medicine doctors to review imaging on display terminals located in the department simultaneously with the radiologist.

As the emergency department also serves as a level I trauma centre, it must be able to provide the highest level of trauma care to patients in a large area. The modernisation of the department includes a dedicated elevator and more direct transit route from the helicopter pad to the trauma rooms, for patients arriving by ambulance flight units.

Specialty care is also available. This includes trauma, medical, and surgical specialists as well as ancillary staff and support services.

Lutheran General serves as a model of how patient experience can be improved by modernising the emergency department--modernisation that is focused on patient care, technology, physical layout, and administrative support of the role of the emergency department as an integral part of the hospital.

Oveys Mansuri, fourth year medical student, University of Illinois College of Medicine
Email: omansu1@uic.edu


studentBMJ 2004;12:393-436 November ISSN 0966-6494