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RI ACEP’s Emergency Department Spotlight

Memorial Hospital of Rhode Island

Facts & Figures

Memorial Hospital Emergency Department has 14 beds in the acute care area with two of those designed/dedicated to critical care/trauma patients. We also have a 10-bed fast track area and four observation beds. Our annual volume is 33,000 and we admit 17-15%. We have 37 hours of ED MD coverage and 12 hours of mid-level coverage per day, seven days per week. All of our physicians are BE/BC in emergency medicine.

Patient Population

We treat a wide variety of patient types from the Blackstone and Southern Massachusetts communities.

Developments

We have gone completely electronic with respect to MD and RN documentation, lab and x-ray order entry/resulting, and D/C instruction and prescription printing. We have an all digital x-ray department and a new 64 slice CT scanner.

Charting

We use Emergisoft.

Challenges

Our department faces challenges due to increasing volume and a shrinking number of on-call specialists.

Local Lunch Suggestions

Blaze, Apsara, Modern Diner, or Pizico

Other Comments

We have instituted a pre-hospital 12 lead ECG base station which allows Pawtucket, Central Falls and Cumberland EMS units to transmit a 12 lead ECG for physician guidance on whether the patient they are transporting is suffering a STEMI and needs to be directed to a PCI capable facility.

Information provided by Liudvikas Jagminas, MD, FACEP, Chairman, Department of Emergency Medicine, Memorial Hospital

Newport Hospital

Facts & Figures

Newport Hospital Emergency Department’s yearly census is very stable at 31,000+. There are a total of 17 beds. The ED is divided into the Major Side and the Minor Side. Patients are initially triaged to either side. The Minor Side includes typical urgent care plus some higher acuity walk-in and ambulance traffic. The Major Side is typical higher acuity medical and surgical. The Minor Side is staffed mostly by Physician’s Assistants. The Major Side is staffed by licensed physicians. We have nine licensed physicians and two PA’s on staff with a few per diems that do occasional shifts. Approximately 10-15% of the total ED population (Major plus Minor Side) is admitted. We transfer most trauma patients, neurosurgical, and acute cardiac patients from our ED to Providence.

Patient Population

We see the full spectrum of community Emergency Medicine — adult, all ages of pediatrics, psychiatric, gynecologic, medical, trauma, and surgical. Basically, every type of patient in our catchment area comes to our ED first. It surprises most people to know that Newport County has one of the highest per capita welfare rates of any county in RI. This certainly affects our patient population. We also have an interesting mix of patients due to Newport’s standing as a major tourist destination. This is especially true in the summer months.

Developments

We have an ED bedside ultrasound program, and we use the basic abdominal, transvaginal, and vascular applications.

Charting

We use the MedHost computerized ED tracking, physician order entry, and nursing documentation system throughout the department. The physicians and PA’s use the E-Power Doc paper template charts for their documentation but will most likely be moving to an EMR system in the near future.

Challenges

Our department and hospital are facing the same problems that all other ED’s and community hospitals in the area are facing. Financial pressures caused by repeated cutbacks in healthcare reimbursement and the projected increase in the number of patients with no insurance (or inadequate insurance) due to the current worsening state of the economy have created a situation where it is increasingly difficult to maintain our current high standard of patient care. The role of our ED, like all other similar ED’s, as the safety net of our healthcare system will be more and more difficult over time.

Local Lunch Suggestions

The hospital is located near downtown Newport, which has some of the best bars and restaurants anywhere. For a casual lunch or beer after work, Yesterday’s on Washington Square is very good. There are also many great restaurants on the Newport Harbor.

Other Comments

The ED at Newport Hospital is staffed by Newport Emergency Physicians, Inc. (NEPI), a private, single-hospital group. NEPI was started at Newport Hospital in 1993 and has been there ever since.

Information provided by Glenn Hebel, MD, FAAEM, FACEP, Chairman, Department of Emergency Medicine, Newport Hospital

Kent Hospital

Kent Hospital Emergency Department

Kent Hospital is Rhode Island’s largest community hospital and the second largest hospital in the state. Kent Hospital’s recently redesigned Emergency Department (ED) sees close to 60,000 patients a year, including those with serious illness/injury. This volume ranks Kent’s ED among the top 10-percent nationally. The ED facility has 50 beds, including trauma and cardiac resuscitation areas and a behavioral health area. In October 2011, Kent Hospital announced major initiatives in its Emergency Department establishing it as the first and only hospital in the state to eliminate the practice of ambulance diversion, while also publicly unveiling a new rapid assessment model for patients coming to the hospital’s ED.

The patient rapid assessment model has dramatically reduced waiting time and in many instances it has been virtually eliminated. In the past, the average wait time to be seen when coming to the ED was two hours, while the entire patient visit averaged six hours. Today, with this new model of care, the average wait time is less than 30 minutes and the average overall patient visit is four hours, while efforts are ongoing to not only maintain that but to continually improve it.

Kent Hospital’s ED routinely sees patients suffering from stroke and has a stroke team of clinicians experienced in the diagnosis and treatment of stroke. The Stroke Center at Kent Hospital has earned the Gold Seal of Approval from the Joint Commission for primary stroke centers. In receiving this distinction, Kent has demonstrated the program follows national standards and guidelines that can significantly improve outcomes for stroke patients. Our multidisciplinary clinical team is available 24/7 from the moment of the patient’s arrival in the Kent ED through diagnosis, treatment and follow-up care.

Residency Programs

The Emergency Medicine Residency Program at Kent Hospital is approved by the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA). Affiliated with the University of New England College of Osteopathic Medicine, it is the only dually accredited EM residency in the entire New England region. The emergency medicine residency program (EMRP) trains eight residents per year in a PGY1-4 format. Successful completion of the EMRP leads to eligibility for Board Certification in Emergency Medicine through the American Osteopathic Board of Emergency Medicine (AOBEM) as well as the American Board of Emergency Medicine (ABEM). Kent Hospital also offers graduate medical education residency programs in Family Practice and Internal Medicine, and fellowships in Gastroenterology and Hyperbaric Medicine.

Hospital Facts & Figures

Kent Hospital is a 359-bed, acute care hospital that serves a population base of some 300,000 across three counties in central and southern Rhode Island. With close to 2,200 employees and a medical staff of more than 600 physicians and allied health professionals, the hospital ranks in the top 25% in admissions among hospitals across southeastern New England (including those in metropolitan Boston).

Kent Hospital offers a full range of services and specialties including cardiac catheterization, dialysis, a 15-bed ICU directed by intensivists, a CCU, ECCU, orthopedics, vascular surgery, impatient psychiatry and rehabilitation units and the second-busiest obstetrical department in the state with a Level II NICU. Kent Hospital has a regionally recognized Wound Recovery and Hyperbaric Medicine Center and is the only hospital offering 24-hour emergency hyperbaric oxygen therapy in the region. Kent Hospital recently inaugurated a newly relocated and renovated infusion center, PET scan and sleep study center. The hospital is also home to the state’s largest hospitalist program.

Information provided by Peter Graves, MD, Chairman, Department of Emergency Medicine, Academic Faculty, Kent Hospital Emergency Medicine Residency Program on Thursday, April 26, 2012.