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All posts tagged emergency

Meet the ER doc who thinks like a designer – Philly.com

A heart attack one minute. Mysterious stomach pain the next. A steady stream of fevers, headaches, and shortness of breath. As the safety net of the American health-care system, hospital emergency rooms are expected to be crowded, loud, and chaotic.

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Bon Ku, an emergency physician at Thomas Jefferson University Hospital, thinks there has to be a better way.

For the last two summers, he has deployed teams of students with iPads inside Jeffersons busy emergency department, carefully mapping the movements of doctors, nurses, technicians, and patients. The goal of the project, a collaboration with the KieranTimberlake architecture firm, is to learn how emergency medicine could be improved through good design.

People ask me:Are you just trying to make the E.R. look prettier or polished, with the walls a more soothing color? he said. No. You can design spaces to change the behaviors of people.

Among the early results from the research: colorful heat maps suggesting that physicians spend too much time at computer keyboards at the expense of listening topatients, Ku said.

KieranTimberlake

A heat map shows the locations of five categories of people in the Jefferson emergency department over a 48-hour period: patients (red), doctors (purple), nurses (blue), other staff (green), and family/friends (yellow).

That was no surprise, and certainly not unique to Jefferson, which typically gets at least 65,000 E.R. visits a year. Doctors and nursesnationwide have griped about the amount of time spent entering patient information into electronic medical records. But it has gotten Ku and his colleagues thinking about ways to alleviate the problem. Placing easy-to-use keyboard stations inside patient rooms, perhaps. Or better use of scribes employees who document the care while the physician focuses on providing it.

Ku, who majored in classical studies as a University of Pennsylvania undergraduate and later earned a masters degree in public policy at Princeton, has no formal training in design. But he is determined to get medical students thinking about it.

The E.R.-mapping study is one of 10design projects now underway in the Vault, the basement of a former Federal Reserve building in the 900 block of Chestnut Street that Jefferson owns.The lab is directed by pharmacist Robert Pugliese.

Oneeffort involves using a 3-D printer to make plastic models of patients jawbones, helping surgeons to prepare for difficult reconstructive surgery. In another, student researchers use electronic wristbands to monitor the movements of children in playgrounds, in hopes of determining which structures are most likely to encourage physical activity.

The emergency-department mapping project began when Ku saw a KieranTimberlake presentation of research it had conductedat JFK Plaza: how people use the park, where they sit, and where they stand. Billie Faircloth, a partner and research director at the architecture firm, recalled that Ku approached her afterward.

He said, I need this in my emergency department, she said.

Architects are used to interacting with people who have no formal design training. Listening to clients needs is a core part of the job, after all.But in Ku, Faircloth and her colleagues found someone who was unusually insightful about the potential for good design.

He talked very clearly about what he hoped to achieve, Faircloth said. He is basically looking at design from multiple perspectives.

Jefferson did not hire KieranTimberlaketo renovate the space. The firm offered its services purely for research purposes. Ku and his students are still sorting out what the results mean, and how they might lead to improvements.

The hospitals emergency department treats about 180 patients aday and at least seven every hour, though there is a lot of ebb and flow. Mondays are busiest, with a logjam of untreated ailments that has built up over the weekend. Regardless of the day, volumes tend to be highest from lunchtime until 2 a.m.

The spaceis divided into two wings, and, therefore, could serve as a living laboratory for testing different approaches for providing care. The larger A side has the more traditional E.R. configuration, with one central station for doctors and nurses, surrounded by patient rooms. The smaller B side is decentralized, with nurses separated into pods each surrounded by a cluster of four patient rooms.

Ku likes the B side because it tends to be quieter. But neither side has a good spot for providers to decompress. Kus solution?

I go to the bathroom, he said.

Ultimately, he would like to test which seating arrangements and other design elements might improve patient outcomes.

A recentstudy funded by the Robert Wood Johnson Foundation suggests that better design can, indeed, have an impact. Among the findings: Hospitals with shorter distances between delivery rooms were less likely to deliver babies bycesarean section. When rooms were arranged in a compact cluster rather than strung out along a long hallway, providers could work more efficiently, apparently reducing the pressure to move patients through the system more quickly by performing C-sections, the authors wrote.

KieranTimberlake developed the iPad tool that was used to map the Jefferson E.R., and it was customized for a health-care setting with input from Ku and his colleagues.

Ku, the assistant dean for health and design at Jeffersons Sidney Kimmel Medical College, wants to eventually make the tool available to hospitals anywhere. From what he can tell, there is far too little study of hospital spaces once they are built.

The science of how we build new health-care facilities, he said, should be as rigorous as the science of how we develop new drugs or therapy.

JESSICA GRIFFIN

Bon Ku (center) and medical student Allison David (far left) are studying how to improve emergency medicine with better design.

Published: September 7, 2017 3:01 AM EDT

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Ortho RI Express Provides Immediate Orthopedic CareSaving … – Business Wire (press release)

PROVIDENCE, R.I.–(BUSINESS WIRE)–Ortho RI, Rhode Islands largest orthopedic care provider, offers patients with orthopedic injuries a better alternative to care through its Ortho RI Express immediate care centers. With fall sports just starting and winter around the corner, injuries needing immediate attention are bound to happen.

When a patient gets injured, whether in soccer practice or slipping on the ice, often the only care option involves long waits at the emergency room or urgent care center, said Michael Bradley, MD, President and CEO of Ortho RI. But they are not staffed with orthopedists so patients are often referred out for specialized care. The result is more long waits, extra fees and copays and delayed care.

Ortho RI Express offers an alternative: immediate care from orthopedic specialists for acute situations, available after hours and on Saturday. All four locations are staffed with Ortho RI physicians and physician assistants, with an orthopedic surgeon on call at all times. Patients benefit from their better understanding of orthopedic injuries and faster care. An Ortho RI visit is billed as a specialist office visit instead of the higher emergency room or urgent care visit.

Ortho RI Express eliminates unnecessary emergency room visits for sprains, strains and fractures, Bradley said. With fall school sports just beginning, the timing couldnt be better to remind families there is a one-stop, lower-cost, better-care alternative.

There are Ortho RI Express locations in Providence, Pawtucket, Warwick and Wakefield. Hours are 9 a.m. to 5 p.m. daily, with evening hours 5 p.m. to 9 p.m. and Saturday hours 2 p.m. to 7 p.m. at select locations. Patients may call ahead as soon as the injury occurs and be seen within 15 minutes of their appointment time. The number is 401-777-7000.

Learn more at orthopedicsri.com/ortho-ri-express

About Ortho RIOrtho RI advances orthopedic care through patient-centered comprehensive musculoskeletal care with 14 community locations, more than 55 orthopedic specialists and more than 55 therapists and trainers. Their areas of expertise include: hand, joint, pain management, shoulder, spine, sports medicine, joint reconstruction, primary care sports medicine and podiatry. Ortho Rhode Island also offers physical and occupational therapy, athletic training, MRI and ultrasound imaging, and durable medical equipment.

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Report finds many emergency room visits are avoidable – ConsumerAffairs

When an accident or injury occurs, its second nature for consumers to go to the emergency room (ER) for treatment. But a new report finds that some of these visits arent necessary or advisable.

In a recent study, researchers from California deemed that 3.5% of all U.S. emergency roomvisits were avoidable. They say that the top three discharge diagnoses were alcohol abuse, dental disorders, and mood disorders, such as anxiety and depression. While some of these conditions can be serious, the authors note that the ER is not always necessarily the best place to have them treated.

Our most striking finding is that a significant number of avoidable visits are for conditions the ED is not equipped to treat. Emergency physicians are trained to treat life- and limb-threatening emergencies, making it inefficient for patients with mental health, substance abuse, or dental disorders to be treated in this setting, they said.

The study analyzed over 424 million visits made to emergency departments across the U.S. between 2005 and 2011 for patients aged 18 to 64. Avoidable cases were defined as those that did not require diagnostic or screening services, procedures, or medications, and led to patients being discharged home.

Of these visits, the researchers say that 6.8% were related to alcohol abuse or mood disorders, while 3.9% were connected to disorders with patients teeth or jaws. While the majorityof these visits did warrant emergency attention, the results indicated that 16.9% of mood disorder visits, 10.4% of alcohol-related visits, and 4.9% of tooth and jaw-related visits were avoidable.

While visiting the ER might seem like the safest move, the researchers note that extraneous visits can impact the overall cost of health insurance for all consumers. They believe that their results may indicate a need to increase public access to mental health services and dental care.

Our findings serve as a start to addressing gaps in the US healthcare system, rather than penalizing patients for lack of access, and may be a better step to decreasing avoidable ED visits, the researchers concluded.

The full study has been published in the International Journal for Quality in Health Care.

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Only 3% of emergency room visits may truly be avoidable, study … – FierceHealthcare

Though many emergency rooms are overcrowded and some patients may not have urgent needs, just a fraction of visits are truly avoidable, according to a new study.

Researchers examined datafrom the National Hospital Ambulatory Medical Care Survey from 2005 to 2011 that included more than 115,000 records representing 424 million emergency department visits, and found that only 3.3% were avoidable.The study team defined avoidable visits as thosethat did not require diagnostic tests, screenings, procedures or medications.

A number of these avoidable visits were for concerns that the ER is not equipped to treat, like dental or mental health issues, according to the study. Of the avoidable visits, 6.8% were for alcohol- or mood-related disorders, like depression or anxiety, while 3.9% were for dental conditions.

RELATED:4 strategies to reduce ER overcrowding

The findings, published in the International Journal for Quality in Health Care,challenge the commonly held belief that many people visit the ER needlessly, said RebeccaParker, M.D., president of the American College of Emergency Physicians, in an announcement.

Despite a relentless campaign by the insurance industry to mislead policymakers and the public into believing that many ER visits are avoidable, the facts say otherwise, Parker said. Most patients who are in the emergency department belong there and insurers should cover those visits. The myths about unnecessary ER visits are just thatmyths.

RELATED: ER visits offer a teachable moment to reduce drug use

The ER has been a frequent target for initiatives seeking to reduce overuse and the costs associated with emergency care. However, the researchers saidthat their findings point more toward the value in programs to improve patient access to services like mental health and dental care.

The study found that 10.4% of visits from patients with alcohol-related disorders and 16.9% of visits from patients with mood disorders were avoidable, suggesting that policymakers could do more to increase access to the services that would keep those patients out of the ER.

Our findings serve as a start to addressing gaps in the U.S. healthcare system, rather than penalizing patients for lack of access, and may be a better step to decreasing avoidable ED visits, the authors wrote.

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Only 3% of emergency room visits may truly be avoidable, study … – FierceHealthcare

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Serious Nursing Home Abuse Often Not Reported To Police, Federal Investigators Find – NPR

More than one-quarter of the 134 cases of severe abuse that were uncovered by government investigators were not reported to the police. The vast majority of the cases involved sexual assault. Scott Olson/Getty Images hide caption

More than one-quarter of the 134 cases of severe abuse that were uncovered by government investigators were not reported to the police. The vast majority of the cases involved sexual assault.

More than one-quarter of serious cases of nursing home abuse are not reported to the police, according to an alert released Monday morning by the Office of Inspector General in the Department of Health and Human Services.

The cases went unreported despite the fact that state and federal law require that serious cases of abuse in nursing homes be turned over to the police.

Government investigators are conducting an ongoing review into nursing home abuse and neglect but say they are releasing the alert now because they want immediate fixes.

These are cases of abuse severe enough to send someone to the emergency room. One example cited in the alert is a woman who was left deeply bruised after being sexually assaulted at her nursing home. Federal law says that incident should have been reported to the police within two hours. But the nursing home didn’t do that, says Curtis Roy, an assistant regional inspector general in the Department of Health and Human Services.

“They cleaned off the victim,” he says. “In doing so, they destroyed all of the evidence that law enforcement could have used as part of an investigation into this crime.”

The nursing home told the victim’s family about the assault the next day. It was the family that informed the police. But Roy says that even then, the nursing home tried to cover up the crime.

“They went so far as to contact the local police department to tell them that they did not need to come out to facility to conduct an investigation,” says Roy.

Looking at records from 2015 and 2016, Curtis Roy and his team of investigators found 134 cases of abuse of nursing home residents severe enough to require emergency treatment. The vast majority of the cases involved sexual assault.

There’s never an excuse to allow somebody to suffer this kind of torment.

Curtis Roy

“There’s never an excuse to allow somebody to suffer this kind of torment, really, ever,” says Roy.

The incidents of abuse were spread across 33 states. Illinois had the most at 17. Seventy-two percent of all the cases appear to have been reported to local law enforcement within two hours. But twenty-eight percent were not. Investigators from the Office of the Inspector General decided to report all 134 cases to the police. “We’re so concerned,” says Roy, “we’d rather over-report something than not have it reported at all.”

The alert from the Inspector General’s office says that the Centers for Medicare and Medicaid Services (CMS), which regulate nursing homes, need to do more to track these cases of abuse. The alert suggests that the agency should do what Curtis Roy’s investigators did: cross-reference Medicare claims from nursing home residents with their claims from the emergency room. Investigators were able to see if an individual on Medicare filed claims for both nursing home care and emergency room services. Investigators could then see if the emergency room diagnosis indicated the patient was a victim of a crime, such as physical or sexual assault.

The alert notes that federal law on this issue was strengthened in 2011. It requires someone who suspects abuse of a nursing home resident causing serious bodily injury, to report their suspicion to local law enforcement in two hours or less. If their suspicion of abuse does not involve serious bodily injury of the nursing home resident, they have 24 hours to report it. Failure to do so can result in fines of up to $300,000.

But CMS never got explicit authority from the Secretary of Health and Human Services to enforce the penalties. According to the Inspector General’s alert, CMS only began seeking that authority this year. CMS did not make anyone available for an interview.

Clearly, the 134 cases of severe abuse uncovered by the Inspector General’s office represent a tiny fraction of the nation’s 1.4 million nursing home residents. But Curtis Roy says the cases they found are likely just a small fraction of the ones that exist, since they were only able to identify victims of abuse who were taken to an emergency room. “It’s the worst of the worst,” he says. “I don’t believe that anyone thinks this is acceptable.

“We’ve got to do a better job,” says Roy, of “getting [abuse] out of our health care system.”

One thing investigators don’t yet know is whether the nursing homes where abuses took place were ever fined or punished in any way. That will be part of the Inspector General’s full report which is expected in about a year.

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Serious Nursing Home Abuse Often Not Reported To Police, Federal Investigators Find – NPR

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New emergency room among big changes at Rapid City hospital – Huron Daily Tribune

Updated 10:21am, Saturday, August 26, 2017

RAPID CITY, S.D. (AP) A $200 million transformation of Rapid City Regional Hospital has begun with the completion of a three-level parking garage.

The Rapid City Journal reports the most profound upcoming changes include the move of the hospital’s main entrance from the north side to the south side of the building; integration of inpatient and outpatient cardiac care services; expansion of the emergency department and the addition of another parking garage.

“Two years from now what we’re going to see is something completely different, better access for patients and better access for all of our clinical teams,” Paulette Davidson, the hospital’s chief operating officer, said at a Tuesday gathering inside a recently completed 754-space parking facility just south of the main hospital complex. “And this is just the beginning.”

The new, three-story front entrance will be made with glass, and the 36,000-square-foot emergency department will have more patient beds and medical offices.

The new emergency department will be 150 percent larger than the current space, which is already the busiest in the state with 85,000 visits per year. It’ll include five trauma exam rooms, more than 30 private exam rooms, enclosed parking for six ambulances and elevator access to a rooftop helipad.

A 30,000-square-foot intermediate care cardiac unit with outpatient offices of the Heart and Vascular Institute will be located on the level above the new emergency department.

“It’s going to be a fantastic change and will continue to advance the level of cardiac care that people have become accustomed to,” said Joseph Tuma, a cardiologist.

The project is slated for completion in 2020.

___

Information from: Rapid City Journal, http://www.rapidcityjournal.com

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New emergency room among big changes at Rapid City hospital – Huron Daily Tribune

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New emergency room among big changes at Rapid City hospital – News & Observer

A $200 million transformation of Rapid City Regional Hospital has begun with the completion of a three-level parking garage.

The Rapid City Journal reports the most profound upcoming changes include the move of the hospital’s main entrance from the north side to the south side of the building; integration of inpatient and outpatient cardiac care services; expansion of the emergency department and the addition of another parking garage.

“Two years from now what we’re going to see is something completely different, better access for patients and better access for all of our clinical teams,” Paulette Davidson, the hospital’s chief operating officer, said at a Tuesday gathering inside a recently completed 754-space parking facility just south of the main hospital complex. “And this is just the beginning.”

The new, three-story front entrance will be made with glass, and the 36,000-square-foot emergency department will have more patient beds and medical offices.

The new emergency department will be 150 percent larger than the current space, which is already the busiest in the state with 85,000 visits per year. It’ll include five trauma exam rooms, more than 30 private exam rooms, enclosed parking for six ambulances and elevator access to a rooftop helipad.

A 30,000-square-foot intermediate care cardiac unit with outpatient offices of the Heart and Vascular Institute will be located on the level above the new emergency department.

“It’s going to be a fantastic change and will continue to advance the level of cardiac care that people have become accustomed to,” said Joseph Tuma, a cardiologist.

The project is slated for completion in 2020.

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New emergency room among big changes at Rapid City hospital – News & Observer

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A View of the Epidemic: At the ER, New Complexities – Valley News

Lebanon Its hard to imagine someone more directly involved in the opioid epidemic through his work than Thomas Trimarco. Hes an emergency medicine physician at Dartmouth-Hitchcock Medical Center, where hes worked since 2012.

Emergency rooms, of course, in some ways serve as one of the front lines in dealing with fallout from the epidemic. Its where opioid users are taken when theyve overdosed. Its also a place where users might go to feign a condition in the hope of securing narcotics.

Dartmouth-Hitchcock officials couldnt readily produce statistics on the number of opioid-related cases it handles in the emergency room, but Trimarco, 37, has no doubt it has increased substantially in the number of people he sees with serious, chronic conditions resulting from intravenous drug use, such as infections of the spine, heart and brain.

Those can lead to significant problems that cant necessarily be taken care of at the smaller, community hospitals, said Trimarco, who also serves as medical director for 27 local emergency medical service agencies. So, weve seen a significant increase in the amount of patients who are being transferred from (other) hospitals that are ending up in our emergency department and in our facility with these more serious, long-term complications.

Such cases were once relatively uncommon, but the amount that were seeing now is very significant. Instead of kind of an interesting, once-in-a-while case, its a pretty common case these days.

While some patients come to the emergency room seeking drugs to feed their habit, Trimarco said DHMC has not seen an increase in such patients recently.

I dont think were known as a candy shop, he said.

Because drug seekers often come in complaining of pain-related conditions, such as those that are commonly treated with opioids, it can sometimes be difficult for providers to determine whether a patient is seeking drugs to feed a habit or is in need of medication to treat an acute medical need, he said.

We like to think the best of patients and surely we will give them the benefit of the doubt, Trimarco said.

His job though is to evaluate a patient to determine what their medical need might be.

Once weve eliminated the acute medical issue that might be going on other than the substance abuse … We try to be upfront and honest about our ability to prescribe (opioids) for chronic pain issues out of the emergency department, he said.

There are times when Trimarco has to speak firmly and bluntly with patients who just want to feed their habit.

Most of the time the overall interaction is reasonable and goes well, he said. But, patients can get upset and angry when they are looking for what they think they need or deserve in coming into the emergency room.

In some cases, patients may become violent, Trimarco said.

Trimarco was assaulted twice while working in an emergency room in Cincinnati, prior to coming to DHMC. In one instance, he was punched in the face, in the other he suffered a broken rib. Though both assaults predated the opioid epidemic, they did involve substance use, he said.

Violence against health-care providers is a problem throughout this system and the nation, he said. Its certainly complicated and, perhaps, increased by the opioid epidemic that were seeing. We are seeing more instances of risk to providers both in the ED as well as in the hospital over the last couple of years.

Health care providers face another danger as a result of the epidemic: toxic substances. Even a trace amount of fentanyl or carfentinal narcotics frequently used by addicts could cause a fatal overdose. Such substances may lurk on patients clothing or belongings when they arrive in the emergency room or when emergency medical personnel arrive on a scene, Trimarco said.

No longer can we just kind of dive in and start treating that patient, he said.

If providers suspect patients may have toxic substances on them, they may need to remove and bag their clothing, or take a shower, Trimarco said.

He and the emergency room staff have to deal with overdoses and medical conditions related to intravenous drug use, but the epidemic has also forced him to question whether the standard emergency-room approach is adequate to the task.

As emergency physicians, were really trained to diagnose and to stabilize the acute medical problem thats in front of us, and once that stabilization is achieved were able to hopefully pass that patient along to another provider that would specialize in the longer term care of whatever the ailment, injury or illness is, Trimarco said.

What weve recognized, though, is the exposure that we have to a patient in the emergency department is sometimes the only chance that the health care system has to access these patients and to offer them this support that they may be in need of.

Aiming to break the cycle of addiction, emergency-room staff have started a peer-recovery coaching program.

We will identify patients who may benefit from this program and well call in a recovery coach to spend some time with that patient and offer some support to that patient, both for their current emergency department visit as well as, hopefully, going forward as they try to deal with the long-term addiction that theyre struggling with, he said.

Shifting to addressing patients longer-term needs, however, has come at a cost. What might previously have been a one- or two-hour visit can sometimes last much longer, which can mean longer waits for other patients, he said.

It does have significant downstream effects for all of the other patients in the community who are coming in for emergency care, but these patients are as important as all of our other patients and we still prioritize them and all of our patients according to severity, said Trimarco.

Providers approach those struggling with substance abuse differently than they did in the past, Trimarco said.

I think we all do a little bit of a better job of recognizing the significant struggle that our patients are having dealing with substance abuse these days, he said. I think the patients are less stigmatized than they have been in the past, perhaps.

In some cases, health-care providers also struggle with substance abuse.

Before coming to D-H, I worked at a hospital and we had a young, tremendously talented nurse in our emergency department that died of an overdose, and so I dont think anybody is immune to this epidemic, he said. You see it in many different ways, both when youre working clinically and … it certainly spills over to our personal side as well.

Its a privilege to be able to see and treat patients in some of the worst times of their (lives), but at the same time that can take a toll on you and you certainly need to find a way to appropriately and positively deal with those stresses to be able to continue to do your job and serve the patients that we try to serve, Trimarco said.

Sometimes you just need a little bit of a breather, he said. A lot of times the issues that we see just constantly remind us of the blessings and the amazing things in our own lives.

Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

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A View of the Epidemic: At the ER, New Complexities – Valley News

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Utah’s ER Nurse of the Year’s 38 years of service an anomaly – Deseret News

Utah Valley Hospital

Jean Lundquist working at the ER of Utah Valley Hospital earlier in her career.

PROVO They say home is where the heart is. For Jean Lundquist, her heart lies in the emergency room.

“I was in the hospital when I was probably 7 or 8 years old,” said Lundquist, an ER nurse at Utah Valley Hospital. “I just thought it was cool. I always wanted to do something like that. I always wanted a stethoscope, I always wanted medical stuff.”

Now, when people ask how long she’s been in this line of work, it takes a lot of thought and staring at the ceiling while trying to do math in her head. Lundquist settled on 38 years.

“When I first started, I worked up in Idaho at a small hospital and then worked on the ambulance up there,” she said. “It was awesome.”

Surviving in the realm of emergency medicine for nearly four decades makes Lundquist a bit of an anomaly. “The average burnout rate for an ER nurse is five years,” she said.

Lundquist believes that’s because the stress level is always high in an emergency room.

“You can be sitting there doing nothing, and then bam, you’ve got five people from a car wreck, and somebody with a heart attack, ” she said. “Even when there’s nothing going on, there’s the potential of something coming in.”

Even for those who become accustomed to the constant stress, there are days that stick with them.

“We see people die almost every day,” Lundquist said. “There’s been times where I’ve thought ‘I’m never doing this again.’

“One of the big days was, we had a little 18-month-old that had been run over by a car, and I had a daughter who was 18 months old,” she added. “I went over to day care and just laid by her and just bawled.”

Keeping the job from affecting personal life can be a monumental task, especially when you can’t help but feel attached to those you treat, Lundquist said.

“The people that come here, this is a horrible day in their life,” she said. “They’re either losing a loved one, or they might lose a loved one, or they themselves are really injured.”

Her hard work over the past 38 years isn’t going unrecognized. The Bureau of Emergency Services and Preparedness recently honored Lundquist with Utah’s Emergency Nurse of the Year Award.

Her fellow nurses say Lundquist’s attachment to her patients poses a challenge but also is one of the reasons she’s so deserving of the award.

“Always treating everyone, the psych patients, the homeless. You know, no matter what your place is, she just treats everyone with respect,” said Tina Dewey, a registered nurse at Utah Valley Hospital.

While Lundquist appreciates the accolade, the hope of recognition certainly isn’t what’s kept her in the emergency room for decades, while so many others switched to different departments.

“I remember all the good parts, where you helped somebody, and they come down the next week and shake your hand and tell you ‘thank you,'” she said, while also calling attention to the benefits of finding support among her colleagues. “Sitting around with friends after a shift, going over it with everybody.”

Lundquist has also found acclaim around the hospital. While she still gets called to the ER, she spends most of her time in an office as manager over the hospital’s entire trauma program.

But she doesn’t like talking much about her award or other recognition she’s received over her long career. Instead, she wants to encourage others to follow the same path she has because, despite all the heartache, there’s no other place she’d rather call home.

“Don’t give up because it’s hard,” she said. “You can do hard things. And once you find out what you’re passionate about, do it every day.”

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Prejudice in the emergency room – Yale News

by Natasha Strydhorst August 22, 2017

Esther Choo, M.D. ’01, wrote a Twitter thread that has brought national attention to racism in medicine.

Every so oftena few times a yeara patient at Oregon Health and Science University (OHSU) hospital in Portland refuses treatment in the emergency department from Esther Choo, M.D. 01, M.P.H. Its not because they consider her 15 years medical practice too paltry, or her School of Medicine degree insufficientbut because she is not white.

Its one of those things that youre never prepared for, said Choo, whose parents emigrated from Korea in the 1960s. Nobody, at any point, has said, Oh, by the way: youre a woman and youre a physician of color; you probably will have experiences like this. So Choo began that conversation with a Twitter thread the Sunday after the white supremacist rally on August 12 in Charlottesville, Va., that ended in violence and with the death of Heather Heyer when a car allegedly driven by a neo-Nazi plowed into a crowd of counter-protesters. In a matter of days, the thread had been retweeted more than 25,000 times (including by Chelsea Clinton and the physician-writer Atul Gawande, M.D.) and garnered more than 2,000 comments. The attention led to Choos appearance on CNN, where she discussed the issue of racism when it comes to patient care. Those patients who refused her capable care, Choo said, either chose to be treated by a white intern over the experienced doctor or walked, untreated, out of the emergency room.

Breathtaking, isnt it? Choo tweeted, To be so wedded to your theory of white superiority, that you will bet your life on it, even in the face of clear evidence to the contrary? That evidence could hardly be clearer: in addition to her 12 years of post-residency practice, Choo has her degree from the School of Medicine, her residency at Boston Medical Center, and work as an associate professor and attending physician at Brown University under her belt. Shes now an associate professor at OHSU, where, in addition to her clinical duties, she studies health disparities, substance abuse disorders, and gender bias. She also writes and serves on the advisory board for FeminEM, a resource for women working in emergency medicine.

Her familys story is a classic immigrant tale. Her parents came to the United States so her father could study engineering at Michigan State University. After receiving his doctorate, he went to work as an aerospace engineer for NASA in Cleveland, while her mother owned a home cleaning service. They became citizens and raised three childrenEsthers two brothers are a biology teacher and a management consultant. Before coming to the school of medicine, Choo graduated from Yale College with a degree in English language and literature.

It took me a long time to get to where I am now, where I dont internalize it at all, Choo said of her efforts to deal with racism at work. But when youre a younger physician and youre still developing your knowledge base, there are so many doubts that you have. So when you encounter someone who looks at you and finds something wrong thats so personal to youthat cannot be separated from youit just creeps into any available areas of insecurity. And somehow you walk away feeling less confident as a physician, because this person is questioning your legitimacy to be there.

It’s one of those things you’re never prepared for.

Choos experience is not unique. Many of the thousands of replies to her thread related similar experiences, an outpouring that raises concerns. An article last year in the New England Journal of Medicine discussed how physicians might deal with racist patients, and in December OHSU released what Choo called a prescient statement advising patients that hate speech and bigotry will not be toleratedand that requests for a specific physician based solely on race will not be honored.

How do we improve the multiculturalism and the diversity of our physician workforce? Choo said. Its really hard if youre presenting some subsets of the physician work force with a harder road to travel.

Nancy R. Angoff, M.P.H. 81 M.D. 90, HS 93, associate dean for student affairs, who recalled seeing the qualities of compassionate care and calm leadership in Choo as a medical student, noted that the issue is a pressing one. More and more, were looking at that as a form of mistreatment that our medical students face, that our trainees face, that we as an institution need to take seriously, she said. We need to foster an environment in which we respect each other.

Hospitals are not selective institutionswe treat everybody who walks in the door, Choo said. We are really thrown togetherpretty intimatelywith our patients, so were going to encounter a wide variety of opinions, and some of them will be extreme intolerance. Its one thing to view it from across the country or on TV, and its another thing to have it in your workplace and up in your face.

Some refuse to believe that Choos experience is genuine. To the doubters, Choo is gracious: Its a hard reality to acceptit shows the darker side of human nature, she said. Injecting a positive note into that darker reality, Choo revealed in her Twitter thread what gives her hope: A few get uncomfortable and apologize in the same breath they refuse to let me treat them, she wrote. You see, its a hell of a hard thing to maintain that level of hate face to face.

This article was submitted by John Dent Curtis on August 22, 2017.

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Prejudice in the emergency room – Yale News

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