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The Changing Face of Emergency Care at Danbury Hospital

Emergency Department responds to changing demographics, population growth

If he had only $1 to spend, Patrick Broderick, M.D., would spend it on additional staff training. Not on a capital investment, but on his investment in intellectual capital.

The chief of the J. Benton Egee, M.D., Emergency Department at Danbury Hospital’s goal is to keep his employees state-of-the-art in emergency care, because, he said, the core of any good Emergency Department (ED) is its people.

“I’d implement educational programs rather than buy more equipment or technology,” said Dr. Broderick. He said he’d provide even more training in advanced cardiac life support, heart disorders, new medications, and disaster preparedness. While the Hospital does provide a plethora of training opportunities, Dr. Broderick said there can never be enough.

Exemplary training and expertise differentiate Danbury Hospital’s ED. Its 12 physicians, 60 nurses, seven physician assistants, technicians and support staff are well trained and experienced in ED care. Eleven of the physicians are certified by the American Board of Emergency Medicine and staff have chose ED as their specialty. They don’t rotate in the ED, but rather, are dedicated to specializing in the treatment of very sick people in crisis.

“A lot of people have misconceptions that the people in ED aren’t as experienced as say, a family physician,” said Brain McCambley, physician assistant. That’s not at all the case.

The ED is home to doctors like William Begg, M.D., board certified and residency-trained at world-renowned Johns Hopkins University and Medical Center in Baltimore. “When you look at the quality of care that patients receive here, that says it all,” said Dr. Begg.

“It takes a special group of people to work in the ED,” added Dr. Broderick. It’s a really rewarding field since you get to impact so many people’s lives, many at a time of crisis when they need support. Our staff aren’t only specialists in their field, they’re also good at putting people at ease and making them feel confident in the care they receive.”

The staff is a source of stability for an area of the hospital where trauma and chaos are the norm. “We have a very stable department and very little turn over,” added Dr. Broderick. “Staff stay because it’s such a good place to work.”

The staff not only cares for patients, but works with the city and state on disaster preparedness and with area companies on first-aid training. It also stands ready to respond to disaster or bioterrorism, like Sept. 11, and provides medical control for the region. This means that it sets the standards for care for the area’s ambulance providers, and operates its own ambulance program, under Hospital affiliate Business Systems Inc., (BSI), which services Danbury.

URGENT, EMERGENCY & TRAUMA CARE

The ED is well prepared to treat three types of patients: those needing urgent care, like a child with a high fever; those needing emergency care, such as a heart attack or serious trauma patient; and crisis intervention.

Over the last three years, the ED has seen a tremendous rise in all three types of patients. Today, more underserved people, especially those lacking medical insurance, turn to the ED for primary care needs. While this isn’t an ideal situation, Danbury Hospital has long subscribed to a philosophy of caring for the total community. “We’d never turn anyone away because they couldn’t pay,” said Gerard Robilotti, president of the Danbury Hospital Development Fund. Danbury Hospital is proud of this fact, but it often means a crowded ED waiting room. For urgent care patients, the average time to be seen is 52 minutes, which the staff is eagerly working to reduce. Very sick patients are seen right away.

Also adding to the patient influx is the fact that more patients are coming to the ED with a lot more serious health problems. In addition to children with cuts and colds, many elderly patients come to the ED with problems stemming from multiple illnesses.

“As people are living longer, we’re seeing patients who are older and sicker,” said James Cooper, administrative director of the ED. “Many of our patients have really complex problems that need comprehensive diagnosis and treatment.” More than 50 percent of ED patients are admitted.

According to Dr. Begg, about 25 percent of the patients he sees need major evaluation, testing, diagnosis and treatment. The other 75 percent comprise more routine problems, like coughs, colds and broken bones.

It’s not uncommon, according to Cooper, for an ED doctor to treat an elderly patient suffering from diabetes, high blood pressure and having a heart attack. For example, in the past eight months, the ED provided 9,500 EKGs, which translates to 40 times a day. “That number is astounding,” said Cooper, “and is only expected to increase.”

Another fact that the ED is most proud of is its response rate to administering medications to heart attack victims. Thrombolytics, or “clot-busters,” should be given in the first 30 minutes following a heart attack to be most effective. Danbury’s median response time, year to date, is 26 minutes. “This shows that Danbury Hospital’s ED runs like a very well-oiled machine,” said Robilotti. This is only possible, with the cooperation and professionalism of Danbury’s area ambulance corps, which reports to the ED from the ambulance and prepares physicians for the patient’s arrival.

FAST GROWTH

The ED is one of the fastest growing areas in health-care today, not only at Danbury Hospital, but throughout the country. ED growth is about 15 percent in the United States, with Danbury Hospital at 17 percent, according to Cooper. Last year, Danbury Hospital had 60,000 visits, which translates into an average of 164 patients a day. It’s not uncommon for the ED to have up to 250 patients a day. When the facility was renovated in 1997, 40,000 visits were projected, so already, the facility is poised for expansion.

Dr. Broderick attributes the growth to two factors: 1. General population increase in the greater Danbury area, and 2. Expansion of a population without health insurance who have difficulty accessing medical care. “The ED is the safety net for the community,” he said. “They know they can always get care here.” It is estimated that there are 40 million uninsured or underinsured people in the United States. The staggering growth numbers will only increase, he said, as baby-boomers age in the next 15 to 20 years. According to Cooper, this change in demographics and rapid growth may require EDs around the country to re-engineer they way they provide care.

MEDICAL CONTROL

A key to the success of any ED is a good working relationship with the surrounding ambulance providers. Danbury Hospital, through BSI, provides what is called “medical control” for the region. That means it provides medical direction and sets the standards of care for response time and treatment, what EMTs and paramedics can do, and how procedures run. “Our state of readiness is just phenomenal,” according to Cooper. Danbury Hospital is constantly raising the bar on standards and providing continuing education for all ambulance personnel.

It works with all13 area ambulance services, whose EMTs and paramedics work under the supervision of the ED physicians. For example, if an ambulance responds to a stroke victim, the EMTs and paramedics are immediately on the phone with the ED physicians for orders and medical supervision. They stay in contact throughout the trip to the hospital, where physicians will be well prepared for a fast response.

DISASTER TRAINING

While Danbury Hospital has always been ready to respond to any disaster, it has become more alert since Sept. 11. “Our disaster planning process was always there,” said Dr. Broderick, “because as an ED, we have to be ready for anything. But after Sept. 11, we’ve shifted into higher gear.”

Over the past year, the staff has participated in increased disaster training and a drill, working with the city on a mock contamination disaster.
Even before Sept. 11, Danbury Hospital took a big interest in working with the city and state on a disaster preparedness plan with the establishment of a Bioterrorism Task Force. Last spring, it held a Medical Town Meeting for the community, giving tips on what was being done to keep residents safe.

“We had already begun to think the unthinkable,” said William Gemmell, M.D., vice chairman of Emergency Medicine and Bioterrorism Task Force member. The Hospital’s multidisciplinary Task Force partners with community agencies, regional town officials, the Connecticut Hospital Association, Yale New Haven Hospital and other health-care agencies to write a disaster readiness plan for the greater Danbury area.

Dr. Gemmell said that while the area is better prepared than pre-Sept. 11, more work still needs to be done. “We all have to believe that this will be a way of life for us for a very long time.”

The state will also soon be working with local hospitals to distribute federal funding for disaster training and to establish an integrated operational response infrastructure and communications system, according to Dr. Gemmell. One of the systems already in place is a computer-based response system. Cooper monitors the Disaster Command Center, a computer located in a room in the ED. In the event of an attack or disaster, a beeper alerts Cooper to check the Command Center computer. “I think what Sept. 11 showed us, was that better communication is needed between the state, local hospitals and pubic safety institutions,” he said.

Dr. Gemmell agrees. “It’s a work in progress; we’re getting there, but we need a lot of financial support.”

COMMUNITY STEWARDSHIP

Caring for patients isn’t the only role of the ED – it also cares for the community and its corporate partners. It often provides training on first aid and medical care to local corporations. For example, in the past 10 years it has trained companies on how to use a heart defibrillator in an emergency, and has provided CPR training to thousands of persons. With new equipment, it could train even more people, according to Cooper.

If a company would like more information on first aid training, contact 797-7554, ETR@danhosp.org.

WAYS YOU CAN HELP

There are many ways donors can make a difference at the J. Benton Egee, M.D., Emergency Department at Danbury Hospital. In the next few years, the Hospital will be poised to make improvements in the ED to keep up with the region’s rapid growth. Right now, it relies on the Hospital’s equipment, but several pieces of its own technology will make patient care easier and more expeditious. Here are just a few ways you may want to help:

• List new equipment needs here, like multi-detection CT, CPR training equipment etc.
• List training needs???