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Years Of Planning And Construction Lead To A One-Day Transition

Tomorrow we’ll be far away

Tomorrow is the judgement day

Tomorrow we’ll discover what our God in heaven has in store

One more dawn…

On an unrelated note, tomorrow morning at 5AM our new ER opens and the old one closes down. I’ll be there working clinically. To the degree that it doesn’t interfere with patient care, I’ll live-tweet the experience.

For those not familiar with the institution or the project — it’s a 110,000 annual visit ER closing down and reopening next door in a new, state of the art 83 bed ER, with an entire new 10-story hospital opening directly above at the same time, more or less. The logistics of the transition are pretty staggering. The ER will be the first unit to open. The old ambulance bay will have a barrier put up at 5AM and the new department’s ambulance bay and drop-off will be illuminated at that time and all new patients will go there. The staff closing out the old shop will dispo all the patients they can, and at a certain point, maybe by ten AM, any patients still in the old ER will roll across the skybridge to the new facility. We will open one cath lab and one OR in the new hospital while retaining capability at the old rooms. New patients admitted will go to the new tower and the old inpatient units will start discharging patients. By Friday, any patients still in the old tower will move across to the new inpatient units. They’ll be bringing the other ORs and interventional labs online in a stepwise fashion during the week. Interestingly, a lot of expensive equipment is being “salvaged” from the old hospital. For example, the telemetry monitors in the ICU — about half of the new ICU beds have monitors now. When a patient is discharged from the old ICU, they will take that monitor across to the new building and install it in a new ICU bed, which will only then become open for a new patient. Eventually, all the monitors will be re-installed in the new units. Elective surgeries are pretty much out this week. When everything is open we will have 16 ORs and 8 cath/vascular/EP labs with room for four more as need demands.

For the ER (and more importantly for ER patients) this will be a banner day. For too many years we have had many patients who received the entirety of their ER care in a hallway gurney. While the care has been good, it’s a miserable experience to be in the hallway. Now all the rooms are private, both visually and acoustically.

New ED

And did I mention it’s kinda big? A football field on each side, for perspective. 63 regular treatment rooms, 8 resuscitation rooms, 4 trauma rooms and 4 secure psych rooms. All the treatment rooms are identical in size and equipment. The “major” rooms are also identical to one another — no hunting for gear. Major rooms also have built-in patient lifts mounted in the ceiling (as do all inpatient rooms). Subdivided into three autonomous sub-ERs with the NW zone being peds/fast track focused. One CT scanner in the ER with more CTs and MRI one floor up. Our processes are tight now in the old ER — the average time from door to bed is 9 minutes and the time from bed to doctor is about another 20 minutes. We hope to improve that in the new ER. The idea is “no triage” — patients come directly back to a bed and have their registration and nursing assessment performed there. This eliminates the latent period, wasted time in layman’s terms, of triage and the waiting room.

I walked through the hospital today and watched folks on every single unit frantically preparing for the opening. They were stocking all the little last-minute items — spectralink phones, toothbrushes, etc. It’s amazing to see a hospital slowly come alive like this. Not all was quite right — some workers in their wisdom decided to install the wall-mounted chart rack directly on the whiteboard the ED docs were to use for communication. Huh? Oh well, that will all get ironed out in time.

For my part I am terrified about the parts I had responsibility for — how many docs will be there and when they are there and what rooms they are assigned to. If the patients don’t show up (there is a new freestanding ER ten miles south) we could be horribly overstaffed and take a financial bath. If the “Field of Dreams” principle holds — “If you build it, they will come” — we could be understaffed with no way to rapidly hire more doctors. I have no clue. If our finely engineered complex processes break down, it could be chaos. As they say, the best battle plan lasts only until the first bullet flies. We will, I am sure, be rapidly re-engineering things.

This has been a huge project, in which I’ve played only a tiny peripheral role. I can honestly say that I am incredibly impressed by the foresight, the preseverance, the effort and the care that has been put into this undertaking from every level, from the CEO to the nurses to the housekeeping staff. Hundreds and hundreds of people have dedicated years of their lives to planning for this. I can’t take the least bit of credit for this accomplishment but I am incredibly proud to be part of this organization.

*This blog post was originally published at Movin' Meat*


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One Response to “Years Of Planning And Construction Lead To A One-Day Transition”

  1. Wally says:

    Where are you located?

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Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

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Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

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Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

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As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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