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Belleville OKs Clara Maass emergency room expansion –

A rendering of the proposed Emergency Department renovations at Clara Maass Medical Center in Belleville.(Photo: Mollie Shauger/

The Belleville Zoning Board of Adjustment has given its go-ahead for Clara Maass Medical Center to expand its Emergency Services department.

As previously reported, the hospital was seeking approval for a 1,400-square-foot addition and renovations to its Emergency Department and an 8,000-square-foot courtyard between the ER and a recently built Intensive Care Unit. The application included four variances.

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Domenic Segalla, the chief operating officer and chief financial officer of Clara Maass, appeared before the board on Thursday, July 6, to explain the reasons for the upgrades. Segallasaid Clara Maass is looking to expand the current Emergency Room by adding more space and to segregate pediatrics andbehavioral health treatment areas. Right now, the two areas are commingled, he said.

“Our whole goal isto createand help to expand and create a need that is here for the community, and how do we serve that need. We feel very strongly that right now we don’t have the capacity to provide this need for the community,” Segalla said.

“We’ve spend a lot of time over the last sixmonths trying to become as efficient as we can, and even thoughwe’ve made a lot of progress, it’s still a small setting for the volume we continue to see,” he added.

The hospital sees about 20,000 pediatric visits a year, and about 10,000 behavioral health visits, he said.

As a result of the the Affordable Care Act, more patients are being treated in an outpatient setting, he noted, and some with behavioral health issues don’t necessarily need to be admitted to the hospital.

Clara Maass intends to addmore observation beds for these patients tobe treated and cared for in a safer and more efficient way, but not necessarily admitted to the hospital, he explained.

Also, these treatmentareashave special requirements in that they cannot contain furnishings and other items that a patient could potentially use for committing suicide, he said.

A map shows where the additional construction would occur at Clara Maass.(Photo: Mollie Shauger/

The expansion would also include the addition of 10 pediatric treatment rooms on top of 13, for patients to be examined,he said.

The Zoning Boardbecame hung up on the aspect of parking, as the hospital had proposed eliminating a small number of spaces to enhancethe drop-off area to the Emergency Department.

Board ChairA.J. Del Guercio and Vice ChairWilliam Villanoexpressedconcernthat patients in distress or those who have physical ailments may not be able to walk from another lot 250 feet away from the ER.

The application had proposed a loss of 16 parking spaces overall. However the applicants agreed to provide four additional parking spots at the drop-off area, and to reserve seven in a nearby employee lot for Emergency Room visitors, and not to refuse other ER visitors from parking in the lot.


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Belleville OKs Clara Maass emergency room expansion –


Who pays when someone without insurance shows up in the ER? – USA TODAY

Right now, GOP senators are trying to gather enough votes to pass their Obamacare replacement plan, but even fellow Republicans are having a time a hard time accepting the health care bill. USA TODAY

An ambulance arrives at a hospital emergency room.(Photo: PhotoDisc)

WASHINGTON If an uninsured patient shows up in the emergency room, who pays? The hospital? Taxpayers? The patient? Other patients?

The question is important as Republicans debate health care legislation that could result in more than 20 million fewer Americans having health insurance in ten years.If that happens, some people will go without care. Others will show up at hospitals, but wont be able to pay their bills.

The year the Affordable Care Act passed, hospitals provided about $40 billion in “uncompensated care” that is, care they were not paid for.That was nearly 6% of their total 2010 expenses.

A 1985 federal law requires emergency departments to stabilize and treat anyone entering their doors, regardless of their ability to pay.

But that doesnt mean the uninsured can get treated for any ailment.

Theres lots of medical care we want to consume thats not an emergency, said health care economist Craig Garthwaite, an associate professor and director of the health care program at Northwestern University’s Kellogg School of Management.

It also doesnt mean that hospitals wont try to bill someone without insurance. And the bill they send will be higher than for an insured patient because theres no carrier to negotiate lower prices.

As a result, the uninsured are more likely to be contacted by collection agencies, as they face problems paying both medical and non-medical bills. One study, published in 2016 by the National Bureau of Economic Research, found that someone who goes into the hospital without insurance doubles her chances of filing for bankruptcy over the next four years.

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For the bills that go unpaid, hospitals can try to compensate by charging other patients more. But that doesnt happen as much as many people including policymakers — think.

The authors of the ACA believed thatincreasing insurance coverage through Medicaid and subsidies for private insurance would lessen the cost-shifting that leads to higher insurance premiums. Supreme Court Justice John Roberts also mentioned that benefit in the 2011 decision he authored upholding the laws constitutionality. But researchers havent been ableto document much of a cost shift.

Studying the effects of expanding Medicaid in Michigan where more than 600,000 gained coverage researchers at the University of Michigan havefound no evidence that the expansion affected insurance premiums. They did, however, document that hospitals uncompensated care costs dropped dramatically by nearly 50%.

Conversely, when Tennessee and Missouri had large-scale Medicaid cuts in 2005, the amount of care hospitals provided for free suddenly increased. In a 2015 study published by the National Bureau of Economic Research, Garthwaite and his co-authors estimated every uninsured person costs local hospitals $900 in uncompensated care costs each year.

This is not a trivial thing for a hospital to deal with, Garthwaite said. While hospitals average 7% profit margins, uncompensated care costs can be more than 5% of revenue.

Hospitals do get help with the unpaid bills from taxpayers.

The majority of hospitals are non-profits and are exempt from federal, state and local taxes if they provide a community benefit, such as charitable care. Hospitals also receive federal funding to offset some of the costs of treating the poor.

The ACA scaled back those payments in anticipation that hospitals’ uncompensated care costs would go down. The GOP proposals to overhaul the ACA would reinstate the payments, while making changes to Medicaid and private insurance subsidies that the nonpartisan Congressional Budget Office estimates would result in more than 20 million fewer people having insurance by 2026.


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The return of extra federal payments to hospitals for uncompensatedcare wouldnt be enough to offset the unpaid bills, according to an analysis by the Commonwealth Fund. The study examined the Medicaid changes included in the bill that passed the House in May, and co-author Melinda Abrams said the effects of the Senates pending proposal would be at least as great.

Hospitals operating margins in all states would decline. And hospitals in most of the 31 states which expanded Medicaid under the ACA would have negative operating margins by 2026, according to the analysis.

Ultimately, you have to cut services, fire people, or both, Abrams said. It is shifting the burden of the cost. What is currently shared between the federal government and state governments will be shifted largely to the states. And the burden will be felt by the providers, the patients, the community and the taxpayer.

Pressure from hospitals was often a factor in states decisions to expand Medicaid under the ACA. In some states, such as Indiana, hospitals even agreed to a pay new taxes in exchange for the additional federal revenue from Medicaid patients. Most of the recent decline in hospitals uncompensated care costs has been in states which expanded Medicaid.

And hospitals are among those fighting hard against GOP efforts to phase out the expansion and cap overall Medicaid payments to states.

If these proposed cuts take place, devastation would occur for local rural economies due to hospitals closing and patients incurring huge amounts of debt, Trampas Hutches, CEO of Melissa Memorial Hospital in Holyoke, Colo., said at one of the many events organized by the American Hospital Association and other health care providers in opposition to the GOP bills.

One reason Medicaid has been harder to cut than other safety-net programs such as welfare cash payments is that a large part of the spending is a transfer to health care providers, Garthwaite argues. Thats particularly true for hospitals which are essentially insurers of last resort when there are large coverage gaps.

When policymakers decide not to provide health insurance for a portion of the population that otherwise could not afford insurance,” Garthwaite and his colleagues wrote in their 2015 analysis, “hospitals ultimately bear the cost of that decision,

As President Donald Trump continues to push his agenda of repealing and replacing Obamacare, Americans are not on his side about this. Susana Victoria Perez (@susana_vp) has more. Buzz60

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Who pays when someone without insurance shows up in the ER? – USA TODAY


Report: Opioid use continues to swamp Virginia emergency rooms – Daily Press

In one year, Riverside Regional Medical Center saw an increase of more than 47 percent in emergency room visits related to opioid use.

The Newport News hospital had 26 cases in 2016, compared with 16 in 2015. There were 23 in 2014, hospital spokeswoman Wendy Hetman said in an email.

A national report shows the local hospital is not alone opioid treatment in emergency rooms have surged 99 percent since 2005. There were 1.3 million opioid-related emergency room visits or hospital stays in 2014, the latest year for which complete figures were available.. With the country in the midst of an opioid epidemic, experts expect the numbers to continue to rise, according to the Agency for Healthcare Research and Quality, which released the report.

“Our data tell us what is going on. They tell us what the facts are. But they don’t give us the underlying reasons for what we’re seeing here,” report co-author Anne Elixhauser, a senior research scientist with the agency, told The Washington Post.

The 2014 numbers, the latest available for every state and the District of Columbia, reflect a 64 percent increase for inpatient care and the jump for emergency room treatment compared with figures from 2005, the Post reported.

The sharpest increase in hospitalization and emergency room treatment for opioids was among people ages 25 to 44. The data also show that women are now as likely as men to be admitted to a hospital for inpatient treatment for opioid-related problems.

At least 1,420 people died in Virginia last year from drug overdoses, the fourth year that drugs have outpaced motor vehicle accidents and gun-related incidents as the leading cause of unnatural death, the Virginia Department of Health reports. On Tuesday, the state agency hosted more than 300 health officials, community agencies and law enforcement officers at an opioid summit in Hampton to discuss a drug crisis decades after the “War on Drugs” was declared.

The crowd listened to a series of speakers who talked about coordinating continuous care for drug addicts.

Fred Brason II of the North Carolina-based Project Lazarus, which worked with officials there to create an opioid overdose prevention program, talked about successes the state had with its opioid problems. And he encouraged local officials not to try to copy North Carolina’s program.

“You have to create a program that will work for your communities,” Brason said. “You know your communities and what they need. You have to own it to make it a success.”

Several local agency leaders expressed a need for an agency to coordinate care for people and not just leave them to their own devices to find counseling on their own after facing a crisis. Brason told the crowd if a person is ready and wants treatment, the community has to have services in place to help him or her succeed.

In 2014, fatal overdoses overtook motor vehicle crashes as the most common cause of accidental death in Virginia. Last year, Gov. Terry McAuliffe and state health officials declared the opioid epidemic a public-health emergency in the state.

By this time last year, more than 300 people in Hampton Roads had overdosed on drugs, local police and health officials reported. Sixty-five of those overdoses many of them pertaining to heroin and prescription painkillers were fatal.

When the health department planned the opioid summit, organizers worried they wouldn’t have enough people who wanted to participate, said Dr. Heidi Kulburg, director of the Virginia Beach health department and the Hampton Roads Opioid Working Group.

They were encouraged to see so many people interested in helping, she said.

The Washington Post contributed to this story. Canty can be reached by phone at 757-247-4832.

Report: Opioid use continues to swamp Virginia emergency rooms – Daily Press


RWJUH’s Emergency Room growing in size, scope –

RWJUH in New Brunswick is hosting a two year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients. Wochit

A redesigned and revamped Emergency Department with three trauma bays is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

NEWBRUNSWICK Robert Wood Johnson University Hospitalis going through a growth spurt doubling the size and quadrupling the scope of its Emergency Department (ED). Yet, through these major changes, the EDremains open for business, almost oblivious to the goings-on outside.

In the not-so-distant future, the current RWJUHEDwill becomefocused even more on patient needs andaccess, said John Gantner, CEO and president of RWJUH in New Brunswick. He called the project a “bold undertaking.”

“This is no ordinary community hospital ER,” he said. “A lot of thought has been put into this. It is all about access and unique populations such as behavioral health, infectious disease, trauma patients, pediatric patients and it is what you would expect from an academic health center that is catering at a different level to the communities we serve.The important message is the uniqueness of the project and that is really designed about access and will be an extraordinary ER.”

All services will continue to be offered in a non-disruptive fashion, Gantner said.

“The ER is a source for most of the patients who come into the hospital they come in through the ER,” he said. “So when you entertain a project like this, it disrupts the normal access of flow of patients coming into the facility.There’s some dirt being moved around, but Robert Wood is still in business 100 percent.”

As of June 14, the Emergency Department expansion’s Phase II began. This phase is expected to last six weeks. All vehicles and visitors seeking treatment must access RWJUHs Emergency Department via the intersection of Easton Avenue and Little Albany Street during this time. During this time, this area will be used entirely for Emergency Department and patient-related services. Any non-emergency related drop-offs/pick-ups, deliveries or activities will not be permitted as this project continues. The hospital advises that alternate arrangements should be made. Vehicles entering Rutgers Cancer Institute of New Jersey should access Little Albany Street via Easton Avenue.

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The EDexpansion projectis a direct response to an increasing need for emergency medicine and trauma care services in the greater Central New Jersey area, said Michael Valendo, assistant vice president, nursing and patient services at RWJUH.To cater to this need,RWJUH and RWJ Barnabas Healthlaunched theambitious project, which expands RWJUHs current ED50 percent from 40,000 to 60,000 square feet and its patient load capability from 42to 100 individuals.

“We had outgrown that space,” said Lori Colineri, senior vice president and chief nursing officer at RWJUH.

RWJUH sees about 96,000 pediatricand adult visits each year,said Leigh Anne Schmidt, nursing director for the RWJUH Emergency Department.

“We did some modeling and see it going north of six figures in the next decade,” Valendo said.”To the 110 to 115,000 visit rangebased on demographics in the community and population growth.”

“We have grown every year,” Schmidt said. “It was very important to have the capacity and make sure we are not opening in full the first day.”

Composed of seven different projects, the ED expansion in its entirety is expected to cost $60 million.That includes more than constructionand incorporates movement ofvariousdepartments, including the Respiratory Care Department and some patient units, internally,FaithOrsini, administrative director, construction services at RWJUH. Further, the Rutgers University Clinical Research Department formerly housed in the hospital is movingto the nearby East Tower building.That opened up a great deal of space for the project.

The Emergency Department remains openduring the construction period which is expected to be completed in 2019.

“The majority of the clinical parts of the Emergency Department will be done in two years,” Orsini said. “There will be some tail-end pieces, like offices and back-house space that will go into 2020, but the majority will be done within the firstphases about one-and-a-halfto two years.”

Work is being done to regrade and rework Little Albany Street for new ambulance and front entrances as part of Robert Wood Johnson University Hospital in New Brunswick’s Emergency Department expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: Cheryl Makin/Staff Photo)

The project started in March with exterior construction with thedropping down of 28-inches of Little Albany Street in front of the ED entrance and the establishment of new ambulance and front walk-in entrances.

This work also will allow a new ambulance bay better structured to the needs ofEmergency Medical Services (EMS), emergency and ambulance professionals. The current ambulance bay goes under the building and that areawill be recaptured for interior space, Orsini said.

“The new real estate we get is crucial,” she said. “This allows us to do construction without impacting the operations inside. All of our phasing for the project is on the order of not affecting the daily operations.”

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A new ambulance bay will accommodate eight ambulances at one time. During the planning phase, several local EMSproviders had the opportunity to giveinput on the design.

“This will help our EMS providers too,”Valendo said. “It is much more efficient area for them than what we currently have. There will be an increase in capacity and we have some dedicated space for them not only for their equipment but for their staff as well. That is something we currently don’t have.”

A redesigned and revamped Emergency Department with private rooms is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

Interior construction is expected to begin shortly after a shuffle of departments and offices are complete, Orsini said.

Once complete, the Emergency Department will feature more than 100 private treatment areas for patients with sliding glass doors, as opposed to the current curtained areas. There will be three additional new state-of-the-art trauma bays that can run two traumas at a time if need be.

“That would be six trauma patients at a time,” Orsini said. “And they are being designed pretty close to operating room standard.”

The expanded space also offers patients radiology imaging in the department, adjacentto the trauma area. That detail can potentially reduce wait times for test results, Orsini said.

“The minutes that we can save can potentially save lives,” Valendo said.

A redesigned and revamped Pediatric Emergency Department with sensitivity to special-needs patients is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion project that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital New Brunswick)

The Pediatrics ED, already a part of the current facility, will be relocated to near the front door.

“It’s current location is not necessarily ideal,” Orsinisaid. “Your sickest adults come in by way of ambulance, but your sickest pediatric patients come in their parents’ car. So we will be able to peel those patients off almost immediately as they reach the front door.”

The Pediatrics EDalso willberevamped with special consideration given to sensory and visual needs of autistic and special needs patients with different flooring, lighting, furniture and paint. There will be a special room, called a “Snoezelen”room that is a controlled multi-sensory environment.

“A good population of our pediatric patients are special needs and the sensory and the environment is so crucial to keep them in a calm setting and in designing a new pediatrics ED we would miss the opportunity if we didn’t incorporate this into it at this point,” Colineri said. “Environment is key.”

The unit will remain able to see 17 patients at a time but now with private rooms, a play area and a waiting room housed within the Pediatrics ED.

The new ED model will have a dedicatedinfectious disease room that will be able to segregate those patients immediately. It is able to be accessed from outside, Orsini said.RWJUH is designated as the hospital in the state that handlesglobal diseases, such as Ebola, and has specific trained staff to handle such cases.

Another new section is a 12-room dedicatedbehavioral health/mental health suite, which all agreed is a “critical” addition. There are also several internal family support areas that will be situated throughout the ED.

The new ED’s flow model includesa fast-track option for patients who arrive at the department with less emergent diagnoses, Colineri said.

“It will allow patients to get in and out quicker,” she said.

A redesigned and revamped Emergency Department with private rooms is part of the Robert Wood Johnson University Hospital in New Brunswick’s expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: ~Courtesy of Robert Wood Johnson University Hospital, New Brunswick)

Colineri said it is important for RWJUH to take into consideration what patients and families need.

“When we listen to the voice of the customer, we listen to things like privacy and flow gettingin and out quickly,getting to see their doctor or the person who is going to treat them the quickest,” Colineri said. “So those are the things in the design the flow and the redesign of the emergency room to meet the needs of our patients and families. Get them the quickest service of the highest quality and the safest care and package that.”

Though valet parking is being encouraged at this time due to the outside construction, the parking deck will remain the same. Consumers can either valet park at the hospital entrance on Somerset Street or self-park through the Easton Avenue entrance. Valet parking is open 24 hours during this phase. New Brunswick police also are on site to aid with the safety and direct consumers in the construction area.

The project has several professionals working on the project including John Huddy of Huddy Healthcare Solutions of Fort Mill, South Carolina for space planning and strategic planning, architect Francis Huddy of Philadelphia, DCC Design Group of Wilmington, Delaware for interior design, Langan Engineering of Parsippanyfor civil engineering, Highland Associates of Summit, Pennsylvaniafor MEP (mechanical, electrical and plumbing) engineering and O’Donnell & Naccaratowith offices inPhiladelphia, Bethlehem, Pennsylvania and Mountainsidefor structural engineering.

For more information about the the hospital system, visit

Staff Writer Cheryl Makin:732-565-7256;

Work is being done to regrade and rework Little Albany Street for new ambulance and front entrances as part of Robert Wood Johnson University Hospital in New Brunswick’s Emergency Department expansion project. RWJUH is undergoing a two-year $60 million Emergency Department expansion that will see state-of-the-art advancements and improved privacy, access and flow for patients.(Photo: Cheryl Makin/Staff Photo)

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RWJUH’s Emergency Room growing in size, scope –


IC in Care Series The Emergency Department – Infection Control Today

By Kelly M. Pyrek

Competing priorities, life-and-death situations and a vast quantity of unknown variables are the hallmarks of the emergency department (ED), and compliance with infection prevention and control (IPC) principles and practices can be challenging. Katherine West, BSN, MSEd, CIC, points to the directive from the Occupational Health and Safety Administration (OSHA) — CPL 02-02.069 — that indicates that the delivery of healthcare should not be delayed. “Trauma response is more important than infection control compliance, and even OSHA recognizes that fact,” West says. “We have a duty to meet the patient care needs.”

That being said, abdication of IPC is not acceptable, and infection preventionists and ED personnel must work toward a manageable compromise that can still protect patients and healthcare professionals to a reasonable degree. Researchers are currently endeavoring to study the IPC needs of the ED and determine best practices for better outcomes, as well as determine standardized methods and definitions of compliance monitoring in order to be able to compare results across settings.

In their review, Carter, et al. (2014) examined published literature addressing adherence rates among ED personnel to selected infection control practices, including hand hygiene and aseptic technique during the placement of central venous catheters and urinary catheters, as well as rates of ED equipment contamination. Suitable studies revealed that hand hygiene compliance ranged from 7.7 percent to 89.7 percent, while other studies indicated that aseptic technique practices during urinary catheterization was lacking, and equipment contamination in the ED was persistent.

As Carter, et al. (2014) summarize, “The emergency department is an essential component of the healthcare system, and its potential impact continues to grow as more individuals seek care and are admitted to the hospital through the ED. Invasive procedures such as central lines are placed with increased frequency in certain EDs, but adherence to best practices (e.g., maximum barrier precautions) varies. ED clinicians also face numerous workflow challenges that may foster the spread of infections including crowding, frequent interruptions to care delivery, use of nontraditional care areas such as hallways and conference rooms, and close proximity of patients, who are often separated only by curtains. Given that many of these barriers have been identified as infection prevention threats, it is critical to understand the infection prevention practices of ED providers and their potential role in the risk of HAIs.”

West points to a number of factors that complicate IPC in the emergency department. “The ED is a very challenging area for infection control because it is often a contracted services and staff miss many of the laws and procedures that are important. For example, many are not aware of the HIV testing laws in their state or that HIPAA does not prevent the release of source patient test results to the exposed employee. Rapid patient turnover may impede cleaning compliance. So, compliance monitoring is important. In many facilities, staff is temp staff and that adds to the issues.”

She also emphasizes the need to balance healthcare personnel safety with the need to protect patients. “There is a need to protect patients from infection as well as staff,” West says. “For too long the duty to the patient has often been forgotten. With the new healthcare law, patient protection from infection becomes more important. Patient who develop infection two days after admission, that will be termed healthcare-associated and there may be no government reimbursement for the cost of extended stay and treatment. Staff training needs to focus on proper IV site prep, etc. Training is often not in accordance with requirements for infection control. Attendance at training is important and often not deemed as important.”

Additionally, West emphasizes that “Infection preventionists often do not have enough time to do training in person, which is ideal, so there is time for questions to be answered and items clarified. Paperwork seems to take up so much time. Making rounds and observing care rendered in the ED is very important. Compliance monitoring is key to risk and liability reduction and will also identify training needs. Rounds and training are the best way to interact with ED staff and identify problems.” Let’s take a closer look at several key IPC areas in the ED.

Hand hygiene Carter, et al. (2014) found that hand hygiene was the most commonly observed infection prevention practice in the studies they reviewed, and adherence rates varied widely. For example, several studies examined hand hygiene practices before and after interventions; Haas and Larson used WHO guidelines to assess the impact of a wearable alcohol hand sanitizer dispenser among ED personnel in a New York hospital. The researchers observed 757 hand hygiene opportunities; the adherence rate improved from 43 percent to 62 percent during the first intervention month of the study but was not sustained, with a 51 percent adherence rate after the second quarter.

Scheithauer, et al. (2013) acknowledges that the ED “represents an environment with a high density of invasive and thus infection-prone procedures,” and sought to define the number of hand-rubs needed for an individual patient care at the ED and to optimize hand hygiene compliance without increasing workload. In this prospective tri-phase (6-week observation phases interrupted by two six-week interventions) before after study to determine opportunities for and compliance with hand hygiene per WHO protocol, the researchers evaluated 378 patient cases with 5674 opportunities for hand-rubs (HR) and 1664 HR performed. They found that compliance significantly increased from 21 percent (545/2,603) to 29 percent (467/1,607), and finally 45 percent (652/1,464) in phases 1, 2 and 3, respectively. The number of HR needed for one patient care significantly decreased from 22 to 13 for the non-surgical and from 13 to 7 for the surgical patients due to improved workflow practices after implementing standard operating procedures (SOPs). In parallel, the number of HR performed increased from 3 to 5 for non-surgical and from 2 to 3 for surgical patients. Avoidable opportunities as well as glove usage instead of HR decreased by 70 percent and 73 percent, respectively.

Venkatesh, et al. (2011) conducted an observational study to identify predictors of hand hygiene in the ED. Compliance was 89.7 percent over 5,865 opportunities. The researchers found that observation unit, hallway or high-visibility location, glove use, and worker type predicted worse hand hygiene compliance. Hallway location was the strongest predictor (relative risk, 88.9 percent).

In their study at two university hospital centers, Martel, et al. (2014) found that 53 percent of nurses washed their hands after seeing the patient, and only 40 percent applied recommendation before. However, the researchers note, “given a great turnover of patients, nurses may have just washed their hands after the last patient assessment and be already decontaminated for the next. Some handwashing may have been missed because nurses often left our site of observation immediately before and after seeing the patient.”

Aseptic technique during catheterization In their review, Carter, et al. (2014) identified one study that observed aseptic technique during urinary catheterization. In this study, medical students used standardized observation tools to observe aseptic technique in one ED in the UK and another ED in New Zealand. Procedures observed included urinary catheterization, wound examination or closure, injections or intravascular cannulation, lumbar puncture, and pleural aspiration. Overall, 27 percent (UK) and 58 percent (New Zealand) of invasive procedures were performed using aseptic technique. Adherence to aseptic technique was reported in aggregate and not categorized by procedure type.

Regarding aseptic technique during central venous catheter insertion, Carter, et al. (2014) identified seven studies that examined central venous catheters inserted in the ED or by emergency medicine residents. One study examined the effect of a video review on the sterile technique practices of surgical and emergency medicine residents during the placement of central lines. Compliance to aseptic technique was higher among those who received the video-based online training than those who received paper-based training or no training (74 percent vs 33 percent, respectively). In a separate evaluation, the same research team also assessed maximum barrier precautions among primary and secondary operators through a video recording. Among elective central lines, maximum barrier precautions were used by 88 percent (99/113) of primary operators and 69 percent (31/45) of secondary operators or senior medical staff.

Contact precautions Researchers have found variability of contact precaution policies in U.S. emergency departments. A study published in Infection Control and Hospital Epidemiology in 2014, Daniel J. Pallin, MD, MPH, and Jeremiah D. Schuur, MD, MS, both from Brigham and Women’s Hospital, surveyed a random sample of U.S. EDs confirmed substantial variation in the adoption of policies relating to contact precautions. While most EDs have policies relating to contact precautions when specific organisms are suspected, a minority have such policies for the symptoms often caused by those organisms. This indicated that institutional policies do not mirror consensus recommendations by the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA) and other national bodies. The authors write, “The variation in policy that we observed leads us to recommend that emergency medicine organizations, such as the American College of Emergency Physicians, should enact policies addressing contact precautions in the ED.”

Respiratory hygiene As Rothman, et al. (2006) remind us, “The participation of emergency physicians and nurses is critical for effective responsiveness to respiratory threats in hospitals. ED personnel represent a critical link in the chain of communication and response, along the continuum from the community to the inpatient unit. Policies should anticipate responses to the complex spectrum of possible respiratory illnesses, from highly transmissible and unexpected emerging global diseases such as SARS to yearly influenza epidemics.” They add, “Concerns about the potential spread of respiratory pathogens begin at the point of entry into the healthcare system and continue to the inpatient setting. Emergency personnel need to be aware of the potential for infection, illness, and transmissibility in a variety of potentially high-risk environments, including (1) emergency medical services (EMS) and triage settings (in which historical and clinical information may be limited and risk underestimated), (2) during performance of high-risk invasive airway procedures, and (3) during patient transport to the various inpatient units throughout the hospital.”

Fusco and Puro (2012) observe that “The role of emergency departments in disease transmission dramatically emerged during the outbreak of severe acute respiratory syndrome (SARS). Subsequently, the Centers for Disease Prevention and Control and the World Health Organization issued new infection control guidelines that introduced respiratory hygiene and cough etiquette measures (e.g., covering of nose and mouth possibly with disposable surgical mask, adequate distancing among patients and careful application of hand hygiene) as part of standard precautions to be applied in all health care settings, to all patients with cough and other respiratory symptoms. A rigorous application of this set of infection control measures, including isolation if indicated, may significantly reduce the risk of disease transmission in emergency departments, thus protecting healthcare workers, patients and visitors. Mention about it should be included in all basic sets of indications for the management of community-acquired pneumonia in emergency departments.”

Martel, et al. (2014) sought to determine the compliance with respiratory hygiene of triage nurses at two university hospital centers and to identify factors influencing compliance to the respiratory hygiene principles of emergency healthcare workers. An anonymous observation of compliance with respiratory hygiene by triage emergency nurses was performed, and a self-administered, voluntary questionnaire on attitudes, perceptions, and knowledge of respiratory hygiene guidelines was distributed to the healthcare workers in the ED. The researchers found the average compliance with respiratory hygiene measures of triage nurses was 22 percent; compliance of healthcare workers was 68 percent. Overall, 91.9 percent of respondents believed that a mask was an effective preventive measure. The main barriers to mask use by healthcare workers were tendency to forget (37.8 percent) and discomfort (35.1 percent). Despite clearly visible respiratory hygiene posters in both hospital sites, necessary materials such as masks and tissues were missing in 9.6 percent of the cases. Patient isolation and decontamination measures were rarely or never applied.

As Martel, et al. (2014) observe, “The emergency department is the point of entry into the hospital for many patients and as such constitutes a prime location for the propagation of respiratory infections. These communicable diseases can then be further spread into the hospital as well as back into the community, creating a significant societal burden.” Martel, et al. (2014) found that nurses frequently asked about fever and cough (82 percent), which could be explained by the fact that the emergency room evaluation sheet included an inquiry regarding cough and fever, but they rarely informed the patient of the need to wear a mask (18 percent). The researchers say this could be explained by a lack of knowledge regarding the increased transmission risk in the presence of fever and cough. However, despite the fact that the self-applied questionnaire was not completed by the same healthcare workers, 94.1 percent of them reported that they would recommend mask wearing to a patient with fever and cough. Even though hygiene equipment (such as masks) was present 94.4 percent of the time, only 18.3% of patients had applied the mask recommendations prior to triage.

Martel, et al. (2014) also point out that in spite of CDC recommendations, patient handwashing measures were never met. The absence of posters focusing on this measure, in contrast to the importance of wearing a mask by patient, may result in the slightly higher adherence to the mask precaution (18% vs 0%, respectively). The researchers note, “Several factors could explain that only 9% of nurses informed patients about proper mask technique. Some nurses were seen to request isolation precautions instead. Also, when masks were well positioned, nurses did not further address proper application. Moreover, some nurses may have overestimated patient knowledge regarding the need for mask to cover both nose and mouth and be changed when wet. Despite evidence that spatial separation can reduce droplet spread of infection, we showed a very low compliance to patient isolation (12%).We know that implementation of these measures in many crowded waiting rooms remains particularly difficult. However, both hospitals sites had well-identified areas for this purpose.”

Martel, et al. (2014) recommend the following measures to standardize adequate practices: 1. Visual tools specifically designed for the emergency waiting room displayed prominently (e.g., on the door of the room), encouraging the following basic steps: disinfection of hands and wearing of mask by patient with fever and cough. 2. Modification of present visual tools in waiting rooms to mention real indications for mask wearing: coughing, sneezing, and runny nose and not only fever and cough because they are common. 3. Modification of the emergency department sheet, reminding nurses of the association between fever and cough and the need for patients to wear a mask. 4. Positive reinforcement of respiratory hygiene compliance by supervisors and training on respiratory hygiene/respiratory etiquette of emergency personnel with creation of measures such as online courses aimed at facilitating learning and improving accessibility and flexibility as well as reducing costs.

Equipment contamination In their review, Carter, et al. (2014) identified four papers described equipment contamination in the ED: “Of primary focus was contamination with methicillin-resistant Staphylococcus aureus (MRSA). In one large ED from a United States tertiary care hospital, 7 percent (5/69) of environmental surfaces (chairs, keyboards, telephones, and others) were positive for MRSA compared with no positive sites (0/63) in an outpatient clinic. Another research team took 63 samples of computer mice in an ED in over a one-year period and found only normal skin flora, with no MRSA. In a United States ED, Frazee et al took surveillance cultures of ultrasonographic probes used in the ED; approximately two thirds (111/164) were contaminated with skin or environmental flora, eight samples had heavy growth of skin or environmental flora, and 3.7 percent (6/164) grew organisms including methicillin-sensitive S aureus, Aspergillus, Acinetobacter spp, and mixed Gram-negative rods. Finally, a researcher cultured the stethoscopes of ED nurses and physicians in three Canadian EDs. Of the 100 stethoscopes samples, 70 percent were contaminated. A majority of specimens grew coagulase-negative staphylococci (54/100).”


Carter EJ, Pouch SM and Larson EL. Common infection control practices in the emergency department: A literature review. Am J Infect Control. 42 (2014) 957-62.

Fusco FM and Puro V. Infection control in the emergency department. CMAJ. 184(9):1065. Jun 12, 2012.

Martel J, Bui-Xuan EF, Carreau AM, Carrier JD, Larkin E, Vlachos-Mayer H and Dumas ME. Respiratory hygiene in emergency departments: Compliance, beliefs and perceptions. American Journal of Infection Control 42 (2014) 957-62.

Rothman RE, Irvin CB, Moran GJ, et al. Respiratory hygiene in the emergency department. Ann Emerg Med 2006;48:57082

Scheithauer S, Kamerseder V, Petersen P, Brokmann JC, Lopez-Gonzalez LA, Mach C, Schulze-Rbbecke R and Lemmen SW. Improving hand hygiene compliance in the emergency department: getting to the point. BMC Infectious Diseases 2013, 13:367.

Venkatesh AK, Pallin DJ, Kayden S and Schuur JD. Predictors of Hand Hygiene in the Emergency Department. Infect Control Hosp Epidemiol. 2011 Nov;32(11):1120-3.

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Northwest Healthcare breaks ground on Marana emergency department – Tucson Local Media

Northwest Healthcare has broken ground on a new free-standing emergency department adjacent to the Tucson Premium Outlets at Twin Peaks and I-10. The facility is expected to open in early 2018.

At a May 21 ceremony to commemorate the project, Marana Town Manager Gilbert Davidson said project was part of a very exciting time in the town of Marana.

We love watching dirt get turned, Davidson said. We literally have projects from the southern end to the northern end and this is a nice compliment in the middle.

The move to the new facility represents a shift in philosophy for Northwest Healthcare as it responds to a growing need. Over the past five years, there has been a 20 percent volume increase in emergency room visits. Although Northwest has two hospital-based emergency facilities in the area, the organization wants to get emergency care to areas with growing populations.

Our goal is to provide the communities of Marana, Picture Rocks, Red Rocks, Oro Valley and surrounding areas to easy access to emergency care, Northwest Healthcare Market CEO Kevin Stockton said.

The new facility, which has been named Northwest Emergency Center Marana, will be the healthcare companys second free-standing emergency department, joining a similar facility in Vail which opened in 2015. The Marana location will be open 24 hours a day, seven days a week to serve patients who experience medical emergencies.

The new emergency care center will be just like a hospital emergency room, equipped to treat patients with illnesses and injuries that require a higher level of care than urgent care facilities offer.

The facility will have 12 private patient rooms with radiology and lab services on-site. If a higher level of care is required, patients can be transported quickly to nearby Northwest Medical Center or to Oro Valley Hospital.

Marana leaders have an innovative vision for the future of the town and we are happy to be part of that growth, Stockton said. We have provided healthcare services in Marana for more than 11 years, and this new emergency center reinforces our long-term commitment to caring for this community.

As part of the move, Northwest Healthcare will close the Continental Reserve Urgent Care when the lease ends at the end of the year. The family medicine physicians currently located in the Continental Reserve Urgent Care building will move to new offices at Silverbell and Cortaro and, as Marana grows, Northwest Healthcare will continue to explore other options in the area.

The company also own 58 acres near Tangerine and Moore roads, but currently does not have plans to utilize the property.

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Nestle Purina gives $30K to Trinity emergency room – Fort Dodge Messenger

Nestle Purina, through its Fort Dodge manufacturing facility, donated $30,000 towards the Emergency Room construction and renovation at Trinity Regional Medical Center. The donation enabled the hospital to renovate the Physician Sleep Room, which will help give physicians the rest they need when working long, overnight hours in the ER.

We would like to thank Nestle Purina for their generosity. We see approximately 23,0 00 patients in the Emergency Room at Trinity Regional Medical Center each year, and this donation will help us meet the needs of those patients and the entire community when they need medical care, said Mike Dewerff, president and chief executive officer of UnityPoint Health Fort Dodge.

The hospital has completed the final stages of the Emergency Department project that included new construction and a complete remodel of the existing Emergency Room space. The first phase was completed April 14, 2016, and the Physician Sleep Room was one of the last remaining projects for the second phase of the Emergency Department project. The entire project was completed early this year.

We take seriously our role in helping make the communities where our employees live and work the very best they can be, said Eric Dobson, Purina plant manager. We are proud to join with other local businesses and donors to support the outstanding service Trinity Regional Medical Center provides to our neighbors in the Fort Dodge area.

Nestle Purina, which employs more than 200 people at its Fort Dodge plant, has a long history of supporting the local community, and actively supports many area organizations including the United Way, Almost Home Animal Shelter, American Heart Association, American Cancer Society-Relay for Life, Fort Dodge Community School Foundation and the Fort Dodge Public Library.

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Nestle Purina gives $30K to Trinity emergency room – Fort Dodge Messenger


UH to open emergency room in Kent – Ravenna Record Courier

Free-standing facility to open this summer at S.R. 43 and 261 By BOB GAETJENS Staff Writer Published: May 21, 2017 4:00 AM

University Hospitals will open a free-standing emergency department in Kent this summer, cutting response times nearly in half for area rescue crews.

From the time of an emergency call to being put back in service, an ambulance can be unavailable for up to 90 minutes, Brimfield Chief Craig Mullaly said. Having the new emergency department at will cut that time in half.

“I think this a good, positive thing, definitely,” he said. “Once they are open, they’re an ER. If, worse case scenario, we have something where we have go to the closest facility, they have that life-saving ability.”

The facility will be at the corner of S.R. 43 and S.R. 261 and is expected to open summer, possibly in July, UH officials said.

According to Kent Fire Lt. Patrick Edwards, the biggest advantage of the new center will be the ability to quickly return ambulances to service.

“The patient obviously will get in quicker, and it will enable us to get back into service quicker,” he said. “That’s a huge benefit to us. You’re talking a 5-minute transfer from basically anywhere in the city.”

Joe Wilson, manager of facilities operations for UH, agrees.

He said ambulances often are called for non-life threatening injuries. During the time an ambulance is serving someone with a minor injury, someone else in the community may be having a stroke or heart attack, cases in which timeliness is important.

Tom Conner, director of ambulatory service for UH, agreed that time is a key factor.

“Easier, faster access to emergency care increases your chances of a better outcome,” he said.

Conner said he believes the facility will get patients from Kent, Brimfield, Tallmadge, Stow and maybe some from Rootstown, although UH Portage Medical Center in Ravenna is about the same distance for Rootstown.

The new emergency department will be located in an existing facility that’s been out of use since about 2009, according to Richard Blasko, director of hospital services for UH.

After undergoing about $6.5 million in renovations, the 14,000-square-foot facility will include a large canopy facing S.R. 43 forfive ambulance spaces, according to William Benoit, chief operating officer at UH Portage Medical Center in Ravenna. In the rear of the building is a large parking lot with an entrance for patients who drive to the facility.

According to Wilson, the facility will include eight beds on the emergency department side and six beds on the urgent care side.

Upon arrival, all cases will be treated as emergencies in compliance with federal guidelines, according to Benoit, but as soon as patients sign in, they’ll enter triage where they will be evaluated. More serious cases will remain in the emergency department and minor problems will be sent to the urgent care side of the facility.

“For urgent care, think primary physicians,” he said. “We’ll be able to treat pretty much anything in the emergency department that we’d be able to treat in the ER and the hospital.”

More serious cases likely will be transferred to other hospitals after patients are stabilized, which is where UH has an advantage, Conner said.

“We can send them to Portage if we can provide that service,” he said. “We can send them anywhere in the UH system, to Ahuja (in Beechwood), to Cleveland; it just depends on the level of service needed.”

According to Wilson, the facility will include two specialized areas, one providing obstetrics and gynecological services, which will serve as a rape crisis center, the other for decontaminating people covered in chemicals or other hazardous materials. That area is completely self-contained so hazardous materials do not get into the rest of the facility. The unit includes a shower and is designed to aid patients who’ve experienced industrial accidents involving things like asbestos, PCBs or other harmful chemicals.

The emergency department’s proximity to the medical arts building next door, also owned by UH, will provide access to an imaging center, including MRI, X-rays, a full CT and other services, according to Wilson. That building will be accessible by a walkway, which will be the final part of the renovation.

Benoit said the new emergency department likely will create about 100 new jobs in Kent. At any one time, there will be one full physician, one mid-level care provider, four or five nurses, several paramedics and various support staff on duty.


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Beebe Emergency Department continues to evolve –

Beebe Healthcare provides emergency medical care through its Emergency Department at the main campus at 424 Savannah Road in Lewes. The ED is open year-round, 24 hours a day, seven days a week for the treatment of emergencies and other serious illnesses.

Since its beginning, Beebe has had a history of expansion and growth. Let’s explore the evolution of Beebe’s Emergency Department and the day-to-day operation of this important part of our healthcare community.

Beebe has been the destination for emergency treatment since it opened in 1916. In the early 1980s, the community of coastal Sussex, which surrounds Beebe Hospital, was still in its infancy. Transportation to and from the hospital was often quite difficult, so Beebe Hospital opened a summertime Emergency Room in 1981 in the resort town of Bethany Beach. This was the only freestanding seasonal emergency facility in Delaware, and it was badly needed as our community began to grow.

In 1985, Beebe added its five-story Rollins Wing at the Lewes campus, named for John W. Rollins, which included, among other things, the expansion of diagnostic imaging and emergency services. In 1999, Beebe expanded the Lewes Emergency Department from 13 to 19 beds, and in 2008 the Hudson Wing opened, expanding the Emergency Department to 37 beds.

More than 50,000 patients visit Beebe’s Emergency Department every year. By definition, an emergency situation is unexpected. The patients who occupy the Emergency Department’s 37 beds during a typical 24-hour period didn’t expect a sudden need for medical attention. Many of those patients have been involved in a recreational, workplace, or highway accident. Some experience potentially life-threatening symptoms; others have conditions that demand attention before their regular physicians can see them. And, a number of patients simply have nowhere else to turn for medical care.

“A History of Caring” is how Delaware Gov. Russell Peterson described Dr. James Beebe and Dr. Richard C. Beebe when he spoke at an open house at Beebe Hospital in 1970. And this history of caring continues to this day, as clearly evidenced on a daily basis in the Emergency Department through the compassionate and caring delivery of services by the staff.

“Nurses are dedicated to their work and travel long distances from Dover, Wilmington, Middletown, Ocean View and Bethany. Our work is hard, but it’s rewarding. We care about what we do, and we’re like family,” said Susan Bunting, RN, CNIV, charge nurse in the ED. “The culture of family carries over into the treatment of our patients, and they become part of our family.”

Determining which patient sees a doctor first is critical and is the job of the triage nurse. Triage is an evaluation by a nurse that helps determine the seriousness of the patient’s illness or injury. While waiting cannot be eliminated entirely, the Emergency Department staff hopes improved communication will make any waiting time more tolerable. Currently the average “door to doctor” wait time is 35 minutes.

As Clinical Nurse Tiffany Travis says, “We are constantly figuring out ways to be creative and reduce the time it takes for patients to be seen.”

Visiting an Emergency Room can be traumatic not only for the patient but for the family as well. A Beebe staff member is available as a liaison to patients, bringing frequent updates to the family on how cases are progressing and providing an estimate of how much longer individuals must wait. And, the treatment area has an open environment so a family member or friend can accompany a patient into the ED if they choose, which can ease anxiety for everyone involved.

As the population of southern Delaware has grown, Beebe has expanded its services to meet the needs of our community and now operates Walk-In Care locations on Route 24 in Rehoboth Beach, the Georgetown Health Campus, Millsboro and Millville, which offer satellite imaging, physical rehabilitation and lab services. “The walk-ins have helped us tremendously,” says Sue Ann Newsham, Emergency Department nurse manager. “Four or five years ago we were seeing patients in the Emergency Department who now go to the walk-ins; this frees up space in our ED for us to treat more high-acuity patients.”

Walk-In Care centers do not replace your primary care physician, and information from visits to the Walk-In Care can be forwarded to your physician with your permission. Walk-In Care offers treatment for ailments such as upper respiratory infections, sore throats, sinus infections, flu, laryngitis, allergies, ear, eye, and bladder infections, sprains and minor injuries, gastrointestinal complaints, skin problems such as minor rashes and burns, headaches, minor cuts and simple lacerations, and some limited medication refills.

In the event of a life-threatening illness or accident, you should always call 911. Emergency responders will meet your immediate needs and take you to the appropriate medical facility. Examples of those types of illnesses or injuries for which you should seek immediate medical treatment through 911 or by going to the Emergency Department in Lewes are chest pains or pressure, difficulty breathing, severe bleeding, abdominal pain, spine or back injury, broken bones, or severe eye injuries. Elderly residents who fall and hit their heads should come to the ED. If you twist your ankle and can’t walk, or have any deep lacerations, you should be seen in the ED.

Beebe’s Emergency Department has evolved over the years to become a top-notch Level III Trauma Center in the State of Delaware, and has positioned itself well to provide services to a thriving beach and vacation resort area, and a continually growing year-round population. Beebe Healthcare is very proud of the ED’s Customer Satisfaction scores from Press Ganey. Newsham shared the numbers, “We have sustained a score above 90 percent over the last seven months, and the majority of these months have been above 95 percent.”

Each year, the Beebe Medical Foundation hosts the biggest party of the summer, the Beebe Beach Bash! Beebe’s guests will take over a docked Cape May-Lewes Ferry to enjoy The Fabulous Greaseband, dancing, dining, auctions, and boardwalk games. This year’s Beach Bash Saturday, June 3, will raise funds for Beebe Healthcare’s Emergency Department. Beebe is committed to providing quality care for patients, and this event will allow the organization to offer the most advanced technology to save and change lives.

For more information on how to join in the fun, go to

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Against the odds, emergency rooms are getting people into addiction treatment –

Gina Marchetti walked into the emergency room to a familiar sight: a patient, just brought back from a heroin overdose by paramedics, sweaty and miserable and hooked up to machines. His mother, on her knees next to her son’s bed at Crozer-Chester Medical Center, crying and begging him to get treatment.

“He had the blank stare on his face, saying, ‘I dont need it, I dont need it’ . . . and what flashed before my eyes was when it was me laying in that bed, it was my mom next to me,” said Marchetti, whose sixth overdose four years ago nearly killed her and launched her on a path to recovery as well as a career.

“Thats what gives me the motivation to do every single thing in my power to help this person.”

The young man has been in residential treatment for several months now.

In the Crozer-Keystone Health System in Delaware County, certified recovery specialists like Marchetti succeed about a third of the time.

But inmuch of the Philadelphia region and across the nation, the notion of using an ER visit to propel someone into addiction treatment remains a dream.

In what some call a “warm handoff,” a patient is transferred directly from the ER into a treatment program without cooling off for days in the old neighborhood, around old using buddies, one fentanyl-tainted bag of heroin away from death.

The emergency room seems an ideal place to intervene. A revived patient has just experienced a potentially life-changing event. Hospitals have resources, including doctors and nurses who are passionate about saving lives.

It turns out not to be that easy. Treatment beds are in short supply almost everywhere, forcing a wait of several days even for those who would jump at the chance to get clean. Many people don’t have insurance. Hard-to-change practices some enshrined in regulations, others history and habit may make a smooth transfer impossible even when everyone involved wants the same thing.

Federal law decrees that if a photo ID is missing as it often is when a homeless personoverdoses admission to methadone maintenance programs be denied. Arranging temporary housing and taxi rides requires giving out a patients name, and health-care providers are not allowed to do that.

“I can do a lot for someone who has diabetes or hypertension,” said Priya Mammen, an emergency medicine physician at Philadelphias Methodist and Thomas Jefferson University Hospitals. But for someone addicted to opioids and at grave risk of another overdose? “Physically being able to make an appointment or referring them happens very rarely,” Mammen said.

Frustration drove her to joinMayor Kenneys opioid task force, which was convened in January and could release its final report this week.

“We’re right on the precipice of the whole system actually changing,” Mammen said. Meanwhile, city emergency departments saw more than 6,400 patients who had overdosed last year, releasing nearly all of them after brief physical examinations.

While drug overdoses killed 907 people in 2016 in Philadelphia 80 percent ofthem related to opioids survivors generally suffer little medical harm and walk out.

Mammen recalled a colleague managing to hold one midnight arrival in the ER until dawn so she would not leave in the dark. She came back in an ambulance several hourslater, but this time could not be resuscitated.

Opioid-relatedoverdose deaths quadrupled between 1999 and 2015 nationwide. But it wasnt until 2014 thatNew Jersey and Pennsylvania joined a handful of other statesin allowing ambulance crews and then the general public to administer the emergency overdose-reversal medication naloxone, resulting in thousands of reported saves. (Philadelphia EMTs have used naloxone for decades, but police started getting it only after the change in state law.)

Being revived is physically painful.Naloxone,sometimes sold as Narcan, blocks opioid receptors in the brain, ending the suppressed breathing response that can lead to death. It also throws the person into withdrawal.

Getting someone in that condition to even consider sobriety requires “language of the heart,” said John Brogan, who set up a recovery specialists-in-the-ER program in Ocean County, N.J., even renting room in a church to house people until they could be admitted for treatment, and cajoling programs to offer scholarships. “We meet them where they’re at. Without judgment.”

Jared Brown is one of his success stories. He was in a coma for 12 days the heroin turned out to be laced with rat poison. “Even as I was pulling the needle out, it felt like acid going into my body, getting closer to my heart. I pulled out my phone, dialed 9-1 . . . didnt get to the last 1,” he said. His mother’s boyfriend “heard me gurgling” hours later and completed the call.

Brogan showed up at the other end and they instantly connected over shared histories of drugs and surfing.

Brown had no insurance, but Brogan got him into a Florida detox center and 114 days of residential treatment in Texas. He was released last July and, at 28, is creating a new life in Austin, going to NA meetings and working for a rainwater harvesting company, which just promoted him to foreman.

Officials in Camden County focused on emergency rooms after seeing overdoses spike several years ago. We just had the objective of getting people into treatment, Freeholder Director Louis Cappelli Jr. said. The county has budgeted $300,000 this year to get people started, avoiding the potentially deadly delay of finding coverage for the uninsured.

Recovery specialists working with the county met about 50 people in emergency rooms last year. Nine entered outpatient treatment. The project just expanded, and four more were admitted to a residential program in just the last two weeks.

Gov. Christie has been increasing funding to make warm handoffs possible, and dozens more Camden residents have made it from ERs to treatment without the countys help. In Pennsylvania, Gov. Wolf has increased spending, too.

Delaware County has among the first programs to get off the ground, a year ago, with a small team of recovery specialists ready to visit ERs when overdose cases came in. Four of the six hospital emergency rooms in the county are part of Crozer-Keystone, and the health system for decades has operated a large outpatient addiction treatment program out of the oldCommunity Hospital. The system took over the recovery specialist team in October.

First Steps Treatment Center a comprehensive, 52-bed residential facility opened within the main Crozer-Chester Medical Center on March 22.Now, handling overdose patients is a lot more seamless, said Sarah Falgowski, chief of adult psychiatry a truly warm handoff, with emergency rooms, assessment, inpatient, outpatient, even transportation part of the same system. The recovery specialists have engaged with 447 patients in the last six months, and 167 of them, or 37 percent, have begun treatment.

The young man that Gina Marchetti remembers so well came in late one weekend night. She did not bring up treatment because that might have scared him. She sent his family out of the room. And then she talked about her own life: nine years using, six overdoses, fears of losing her 10-year-old daughter.

He was going through the same experience that I was with the children and the criminal justice system, she said. Realizing he couldnt be a good father kind of flipped the switch for him. He was admitted overnight.

And if hed said no?

We dont just give up,” Marchetti said. My hope is that one time when I call they will have that moment and just say: I cant live like this anymore. Lets do it.

Ready to get off opioids? How to make recovery stick May 12 – 2:16 PM

Voices of recovery: After opioids, many roads to freedom May 12 – 2:08 PM

Opioids in the workplace May 10 – 3:29 PM

Published: May 14, 2017 3:01 AM EDT

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