14 June 2011

The day of reckoning

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 hundred 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.


  1. I envy you the new ED experience. We're supposed to get one in a couple of years, about the same number of beds.



  2. Funny, we've just done the same thing at one of our hospitals.

    Proof, I suppose, that the majority of access for medical care in America in the years ahead will still be via the Emergency Room.

    * Ka Ching *

  3. Job security, if not great health care policy...

  4. That thing is huge! (your ER that is)

  5. That's an amazing facility. Huge. Having just lived through opening a new hospital, I appreciate the effort it takes to open a new facility. Although I didn't have to transition patients too! I don't think I'd care to relive the experience.

  6. Wow, if your measurement is correct (football field by football field) in size, you can measure your ED in acreage too.

    300'x300'=90,000 square feet = 2 acres.

    Never seen an ER that big.

  7. Can you please name the ER? I want to go there should the need arise.

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  9. t's pretty amazing, but if anything it's not quite big enough. With closing down the other campus no real capacity is being added, though at least the patients in the hallways will be in rooms. Still, I suspect that when the waiting room starts filling up it's going to be very difficult to avoid using hallways. There will come a time when every bed is full and patients that can;t wait keep coming in. They could have gone with a hundred beds and used them all.

    I went in yesterday, and it looked (from my POV) like the transition went a lot better than that sort of thing usually goes. Well done to everyone involved.

  10. i give you 30 days to be full of boarders. enjoy the space while it lasts, it won't be long. went thru a similar experience during residency- vastly expanded our space, people packed it full within a month. i hope for your sake your hospital did not make the same mistake as mine- to expand the ED without expanding the upstairs space

  11. Having worked at both Pacific and Colby campuses, I loved watching the tower go up. It's really quite impressive, but I'm not gonna lie...I am nervous when it comes down to ironing out the kinks. Between redirecting incoming patients and employees learning the new layout of the floor...it'll take time. Of course, in the world of medicine, nothing goes as planned but I can see the tower as a huge improvement for everyone.

  12. Yikes.

    Shadow, in all this did anyone think to multiply your ER security?


  13. The idea of a 29-minute door-to-doctor wait is mind-boggling to me. In our ED, patients with non-emergent conditions will frequently wait 6 to 8 hours to be seen. It's just expected that people coming into the ED will have to wait!

  14. We did a similarly tricky move a few years ago when we needed to vacate our 17-bed hospice inpatient unit for a 3-month construction project (and then back again). Although we had only 17 patients to worry about moving to a temporarily unused ward at a nearby seniors home, try moving 17 dying patients receiving end-of-life care. My biggest worry was that one of them might die during transport. They didn't . . . :-)

    Good luck in your beautiful BIG new facility.

  15. 83 beds?! Shit...I'd hate to be the charge nurse in this mutha!

    I love the psych area, although four beds may not be enough. I also love the 4 supervisor rooms right next to the psych area, so that when they are yelling and pounding on the walls, the supervisor can join in the experience.

    Also love discharge waiting room. Wish we had this.

    Good luck and congratuations on what looks like a beautiful new ER.

  16. Wow, that ER is huge! I think I'd get lost just trying to find the right patient.


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