Alex M. Rosenau, DO, FACEP, CPE
Senior Vice Chair of Emergency Medicine
Lehigh Valley Health Network
President-elect, American College of Emergency Physicians
Alex M. Rosenau, FACEP, CPE
Coordination of care is very important. We are looking at observation unit benefits. If a person is admitted for emergency medicine observation, our patients are in and out in an average of 18 hours. But we have some very well defined protocols for observation units; for instance, when internal medicine creates an observation status for an admitted elder patient that has multiple medical problems, we aren't going to be able to get them in and out in 24 hours because there is so much to deal with.
Many hospitals have established a rapid assessment unit where we placed physicians in triage and we emptied out the waiting room. So instead of having a triage nurse, the patient comes right into an area where a doctor, a nurse and the registrar come into the room together, listen to your history, and get your treatment going. We see much more of a role for nurse practitioners and advance practice clinicians.
We need a better infrastructure to interact with and we need to continue making those ties integrated with the outpatient world. At Lehigh Valley Hospital–Cedar Crest, we established a pediatric hospital within the hospital and we opened a pediatric emergency department with 12 beds. It has a lot of support from the community. We have the people who are committed to the care of children and that has also opened up space in the main ED which can then be filled with that coming tsunami of adult patients.