JULY 2003
Volume 27 No. 7

Emergency department expansion, renovation will enhance care

Emergency department expansion, renovation will enhance care An emergency department expansion and renovation project set to begin next month will reduce patient wait times; enhance the hospital's bioterrorism preparedness; provide much-needed storage space; and create colorful treatment rooms designed for children.

Under the project, 1,700 square feet of office space behind the emergency department will be renovated and incorporated into the ED by year's end, increasing its patient-care space by about 25 percent and adding seven new patient beds for a total of 30. A pediatric emergency medicine director is being recruited, and plans call for additional pediatric personnel - including a child-life specialist, nurses and a social worker - to be hired later with funds donated by the community.

The expansion represents the first phase of a three-part, five- to six-year initiative aimed at expanding and updating the ED, enhancing emergency care for children, and ultimately constructing a completely new emergency department.

"This is the beginning of an effort that will allow us to take better care of all our patients - kids and adults," said emergency medicine chief Robert Norris. While the care provided in the ED is excellent, he explained, "the facility can't keep up with our needs."

Built in 1976 and occupying 10,000 square feet, Stanford's emergency department treats some 39,000 patients a year but was designed for less than half that number. Because of the high volume and limited space, patients with non-life-threatening problems must sometimes wait two to three hours to be evaluated. And without adequate storage space, the ED's hallways are filled with equipment such as ultrasound machines, ventilators, and even patient beds when the ED is at capacity.

"This facility is cramped, antiquated and there's stuff everywhere. It's chaotic," Norris said. He noted that patients have little privacy, as some rooms have three or more beds.

In contrast, the renovated area will be attractive and spacious, with all private rooms. Although the current ED space will not change significantly, it will undergo a "facelift" including fresh paint and some new furniture, Norris said.

The ED's look, feel and efficiency have an important impact on the entire hospital, he explained, because 30 percent of all patients admitted to Stanford come through the ED. "This is the front door of our hospital for many people and it makes a lasting impression, so we want to make it a good one."

The space to be renovated - which now houses ED support staff, employee health and the offices of Life Flight - will be vacated by early August and its occupants will move to the ground floor of the hospital. Construction work will begin shortly afterward and will take three to six months, said Nancy Wood, interim director of design and construction for Stanford and Lucile Packard Children's hospitals. Plans for the project, including its estimated cost of $3.3 million, have been approved by both hospitals' boards of directors.

The new space will include seven treatment rooms, work areas for physicians and nurses, and a 275-square-foot children's waiting room to replace the current, smaller children's waiting area.

The seven rooms will all be designed for children (though adults could be treated there as well), featuring bright dˇcor and elements like mobiles. Though these touches might seem incidental, Wood said they will create a comforting environment that will help ease children's anxiety. "From a child's perspective, it really helps to come to a place that looks warm and welcoming," she said. Children account for about 8,000 of Stanford's ED patients each year, or 20 percent, and that number is expected to grow.

Two of the added rooms will be isolation rooms with negative air-flow -ideal for treating patients with infectious conditions such as smallpox, anthrax, radiation contamination or SARS. Patients could access the rooms through a back hallway without coming into contact with other patients and staff. "This unit will definitely make us better prepared for chemical warfare, bioterrorism or a nuclear attack," Norris said.

The addition of new treatment rooms is expected to reduce wait times for all ED patients, but especially those with less serious problems. Since all ED patients currently wait in the same queue, non-critical patients get bumped down the list when more urgent cases come in. Under the second phase of the ED enhancement plan, a "fast-track" system will be implemented in which non-critical patients will be evaluated separately and will move through the ED more quickly.

Norris noted that the leadership of Stanford and Lucile Packard Children's hospitals have made upgrading the ED a priority. SHC chief executive officer Martha Marsh recently witnessed the ED's strengths and limitations firsthand when she spent a shift there with Norris.

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