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Project 1.1.4

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by

Katelyn Lambert

on 1 October 2013

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Transcript of Project 1.1.4

Increase the amount of patient coverage by nurses and physicians
Nurses have the ability to monitor multiple patients if needed
Limits the amount of time spent traveling between rooms down long hallways
SOLUTION
CREATED BY: Katelyn Lambert, Katelyn Moore, Natalie Vaughn
GOALS
Arrange department to maximize patient care and safety
Act upon complaints about emergency department inefficiencies, including
Congested hallways
Slowdown in care when trauma arrives
Inadequate nursing/physician coverage for all patients
Design
Mike Smith:
Patient Information
Arrived: March 16 at 8:15 via private vehicle
Medical History: osteosarcoma in left arm, amputation of left arm
Current Medications: oxycodon, tetracycline
Chief complaints: redness and swelling at incision site of amputation, fluid-filled blisters, black scabs, fluid drainage, fever, chills
Examination Notes: Erythema, bullae formation, necrotic scars, high fever, slightly high BP and pulse
Diagnosis: Necrotizing fascitis, septic
Amber Julian:
Patient Information
Arrived: May 14 at 9:15 via private vehicle
Medical History: no known allergies, may have passed out on way to hospital
Current Medications: all vaccines up to date
Chief Complaints: trouble breathing, bouts of dizziness,
Examination: low blood pressure, high respiratory rate, mild swelling of respiratory tract
Diagnosis: allergic reaction
While He Is There
Who he would see:
Triage nurse- take vitals and note symptoms, may make a preliminary diagnosis
Emergency medicine physician- complete thorough exam of infected area, take blood samples for lab, confirm diagnosis and order intravenous antibiotics
What he would have done:
Blood tests- confirm diagnosis of necrotizing fascitis as well as reveal if the infection has spread into his bloodstream
IV antibiotics
Hyperbaric oxygen therapy- inhibits growth of bacteria
What difference this ER makes:
Immediate triage consultation- speeds up the process that could determine a life-threatening situation; limits how much Mike will expose other patients in the waiting room to the infection
While She Is There
Who she would see:
Triage Nurse: take vitals, note symptoms, make preliminary diagnosis
Emergency Medicine Physician-evaluate patient, confirm or discredit preliminary diagnosis, prescribe necessary medications
Emergency Medicine Nurse: take periodic vitals, monitor condition
What she would have done:
Possible blood and skin tests- test the presence of any allergies she might have to common foods or substances
Epinephrine injection- relaxes the muscles around the airways which will bring the swelling in her respiratory tract down
What differences this ER makes:
Immediate Triage Consultation-speeds up the process that could determine a life-threatening situation
Let's Look at a Case...
Let's Look at Another One...
SUMMARY
Now, a more efficient way to assess and treat patients.
The purpose of the ER is to take in patients with urgent needs for medical care
This design incorporates changes that alleviate the common complaints about the department
The process through which patients go minimizes any hindrance to receiving emergency care, such as a long wait time due to a trauma
The layout of the ER keeps patients within close range of nurses and physicians, who have greater coverage of admitted patients.
References
Evitts, E. A. (2007, April 5). Rethinking the e.r.: Hospital emergency department plans. ARCHITECT, Retrieved from http://www.architectmagazine.com/healthcare-projects/rethinking-the-er-emergency-room-layout-design_1.aspx
Spigel, S. Connecticut General Assembly, Office of Legislative Reseach. (2003). Emergency room standards (2003-R-0001). Retrieved from website: http://www.cga.ct.gov/2003/rpt/2003-R-0001.htm
Guidelines on emergency department design. (2007). Informally published manuscript, Australasian College for Emergency Medicine, Retrieved from http://www.acem.org.au/media/policies_and_guidelines/G15_ED_Design.pdf
Separate Trauma Center
Division of the emergency department into a walk-in emergency room and a trauma center
Prevents any slowdown in regular emergency care when trauma arrives
Prevents prioritizing trauma patients over other patients that require emergent care as well
Wider Hallways and Fewer Rooms per Hallway
Alleviates congested hallways
Decreases the amount of time spent traveling down long hallways
Limits the amount of exposure a patient has to other patients
Centralizing the Department
Changes
We incorporated several innovations into the design of the emergency department that would alleviate the complaints from patients as well as staff.
PROBLEM
Design a more effective emergency medicine delivery system

Propose innovations that will take the medical community a step further into solving the main issues of an inefficient emergency room
Project 1.1.4
Emergency Room Design

Same-Handed Rooms
Rooms are set up with the same layout and equipment
Can be converted into a critical care room as needed
Eliminates the need for specialty care rooms
Patients do not have to travel to a special room to receive care
General ER walk-in entrance
Entered into the triage system at the check in desk
Triage room for vitals-->determined emergent
Decontamination room to the isolation room
Samples collected taken to the laboratory for a diagnosis
General ER walk-in entrance
Entered into triage system at check-in desk
Triage room for vitals-->determined urgent
Back to waiting room
Brought to patient room to have further examination and receive treatment
Observed for few hours to ensure positive response to treatment before being released
Two Triage Rooms
Vitals and symptoms are immediately taken after checking-in; two patients can be checked simultaneously
Minimizes time needed to assess waiting patients to determine priority
Can increase rate at which life-threatening situations are caught before becoming too serious
Main Goals Met
Decrease in waiting time, especially those with urgent needs
Trauma patients brought by ambulance are not prioritized over walk-in emergent patients
Nurses/physicians can manage multiple rooms with the least amount of distance between rooms
Widening and limiting the amount of people needed in each hallway prevents congestion and traffic
Full transcript