AAMC Magazine

Fall 2002

Patients First — Quality Emergency Care

Our Emergency Department Provides Quality Care to a Rapidly Increasing Number of Patients

Patient arriving in ambulance. Flu season is approaching, and that means a bustling Emergency Department (ED) at Anne Arundel Medical Center. The ED’s philosophy is “Patients First,” so the ED team does everything it can to take care of each person who comes in for treatment.

There are times when the ED becomes crowded. On July 5, for instance, the hospital broke a record, providing care to 255 patients in 24 hours. “That’s about one patient every four minutes,” said Debbie Janikowski, Nursing Director of the Emergency Department. She expects that number to increase throughout the flu season, which begins in late November and extends into February. “Nursing supervisors and directors often meet three times a day to evaluate and make adjustments for unexpected numbers,” she said.

Coming to the ED

What happens when I come to the ED?
When you arrive at the ED, please check in at the front desk. If your condition is not critical, you will be given a communication device, much like you receive in a restaurant, so you can leave the waiting area if necessary but remain in contact with the front desk. When you are called, a triage nurse will discuss your needs and assess your condition. Your condition will determine where you will be placed in the ED and the priority in which you’ll be seen. Our emergency team will provide medical and nursing care and contact your primary care physician or a specialist if needed.

How long will I wait?
We will greet you on arrival. Wait times will vary depending upon the number of patients in the ED at the moment, how acutely or critically ill each patient is, and the number of ambulances arriving with critically ill patients. Each patient is important, and quality of care can mean a little longer wait.

Who will see me?
If your condition is less acute you will be seen in the fast track area by a nurse practitioner or a physician assistant. More acutely ill patients are seen by a physician.

Will I be seen faster if I come by ambulance?
Arriving by ambulance versus private vehicle does NOT affect when you are seen. A triage nurse will take your vital signs, assess your immediate condition and review your medical history. Patients are then prioritized accordingly.

When is the Emergency Department least crowded?
Life-threatening medical emergencies never come on a schedule so the ED must be prepared to accept them at any time of the day or night. Generally the ED is less crowded from 2 a.m. to 8 a.m. Typically, fewer patients seek emergency care services on Tuesdays, Wednesdays and Thursdays.

But sometimes patients have to wait, and it can be frustrating. Donna Gilbert, R.N., who has worked in critical care since 1980, and in the AAMC Emergency Department since 1985, said keeping the wait time down is all about communication. “Our goal is always to treat the sickest patients first, while being careful to remember who has been here the longest. That means staying connected with the patient advocate, the triage nurse, the care team coordinator (charge nurse), the primary nurses seeing patients and the physicians. We manage it together minute by minute.”

Gilbert said, “We also have several monthly meetings where we look for trends and discuss ways to improve. We’re always making adjustments.” Medical Director Ken Gummerson, M.D., who will celebrate his 20th year in the Emergency Department next summer, said, “We’ve been astounded at the increase in patients since the hospital moved last year. We expected a 10 percent jump, but instead, we’re seeing closer to 25 percent. I guess that means we’re doing it right—patients tell us that sometimes they are unhappy having to wait, but once they get into a room, they say the care is great.”

“We often say that people come to the Emergency Room with two conditions—pain and anxiety—and we understand that neither of those brings out the best in anyone. But we’re trained to expect that, and we’re confident that we take good care of them all,” said Gummerson.

Janikowski said, “Our team is committed to high quality care, even at peak times. That’s what’s important—to put patients first. We have the same great team we had at the downtown hospital as well as new skilled ED professionals. Each member of the team knows that we, too, could be patients, and we strive every day to offer personalized care.”

Being seen quickly and having privacy are important to patients. The new Emergency Department provides 36 private rooms and separate gynecologic and psychiatric assessment areas. Most patients in the waiting room do not realize there are four separate sections to the ED, and never see the ambulances that deliver patients to the hospital’s rear entrance where eight ambulance bays often are full. “Admitting seriously ill or injured ambulance patients through a separate entrance out of public view increases their privacy but can create frustration among those in the waiting room,” Janikowski said.

In addition to treating patients quickly, it’s also important to release the ambulances quickly so they can return to the road. People want to know that ambulances are available immediately if they need one. The ED staff has worked closely with city and county ambulance crews to meet a 30-minute turnaround time.

Janikowski said, “Our patients can’t predict when they’ll need the Emergency Department. We always have to be on our toes and expect the unexpected. To those who experience a wait, please understand that when we say ‘Patients First,’ we are ensuring that the best possible care is being provided to each and every patient who comes through our doors.”

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