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 need 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, is 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 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

Facts & Figures 

The Kent Hospital ED is the busiest community hospital in RI, with an annual ED volume of approximately 60,000 patient’s visits. The ED facility was renovated approximately three years ago, with an expansion of its footprint to 24,000 sq ft. The facility has 45 beds, including a six room fast track unit (Express Care), a four bed pediatric ER, a two room decon facility, an 11 room general treatment unit that includes a behavioral health area, trauma and cardiac resuscitation areas, and an 18 bed major care unit. The acuity is quite high, with roughly 18-20% of our volume admitted. The ED is staffed by Kent Emergency Physicians, Inc., a single facility fee-for-service democratic group, consisting of 18 full time physicians, as well as a number of per diem emergency physicians and several mid-level providers. Clinician coverage is generous with double attending physician night coverage.

Patient Population

Kent Hospital, which is located in the center of the state, in Warwick, has relatively large primary and secondary service areas, reaching down to North Kingstown and Hope Valley, west to the Connecticut line, and north to parts of Cranston and Johnston. The patient population is typical of larger acute care general community hospitals.  Additionally, we have a regional Hyperbaric Unit with an around-the-clock emergency hyperbaric program for diving emergencies, CO poisonings, frost bite injuries, and several other entities appropriate for hyperbaric oxygen therapy (HBOT).

Developments

In July 2008, Kent Hospital implemented graduate medical residency programs in the area of Emergency Medicine and Family Medicine, in affiliation with the University of New England College of Osteopathic Medicine, in Maine. The EM residency, a PGY 1 - 4 program, was initially approved for six residents per year. Currently we have PGY 1 and PGY 2 residents and we are in the process of interviewing candidates for the incoming intern class that starts July 2009.

Charting  

Several years ago, the ED  implemented the Cerner FirstNet information system, which includes an electronic tracking system, allows for improved reporting of lab results, as well as allowing bedside charting, electronic prescription writing, and computerized (i.e. legible) discharge instructions. The T System physician charting system is also in place. We are currently exploring options to upgrade the institution's PACS. While the Cerner ED information system (EDIS) does have a physician computer order entry component (CPOE), that component has not been brought on line as yet.  

Challenges

There is no shortage of potential answers there. Successfully implementing the EM residency program within the ED and within the institution and across the Care New England Health System, while very exciting, presents an ongoing challenge. In addition, Kent Hospital has undertaken a number of initiatives, which involve changes to daily ED operations, to improve the delivery of care in central RI, such as a recently approved emergency angioplasty program.  Keeping up with advances in technology (i.e. routine CO screening, ED ultrasound) also represents an ongoing challenge.

Memorable Cases

Assuming you will indulge me, I'd like to share two very memorable cases with you. We recently had an elderly gentleman present by rescue for evaluation of chest pain. Despite appearing stable en route from the scene, upon arrival to the ED, the patient had a witnessed cardiac arrest. Despite his very advanced age, given the fact that the arrest was witnessed, resuscitative efforts were prolonged and successful. Ultimately the patient was sent for cardiac catheterization and, according to family, is doing well. That case helped remind the staff on duty that particular shift why we come to work every day. The second case involved a transfer from another faculty. The patient, also an older gentleman, had experienced a significant CO exposure and was exhibiting a marked cognitive decline as a result. After implementing hyperbaric oxygen therapy, the patient began demonstrating improved cognitive functioning. 

Local Lunch Suggestions

Most of the Kent ED physicians would tell you that the hospital's cafeteria does a superb job.  Outside the facility but locally, the options are plentiful. The Bagel Factory on Toll Gate Road offers a variety of great deli sandwiches. Iggie's down in Oakland Beach is also a local favorite.

 -Information provided by Robert G. Dinwoodie, DO, MBA, FACEP, Emergency Department Medical Director and Chief of Emergency Medicine, Kent Hospital, on Wednesday, November 19, 2008.

Emergency Departments in Rhode Island