Meeting the community's needs

Editor’s note: This is Part 2 of a two-part series looking at Sierra View District Hospital’s emergency room. Part 1 looked at the operation of the ER, while Part 2 looks at what’s been done over the years to improve it and what is planned for the future.

From an emergency treatment area in 1958 to the 22 treatment areas of today, the emergency room at Sierra View District Hospital has been open to the community for more than 50 consecutive years.

The original emergency room was part of the hospital district formed by a resolution of the Tulare County Board of Supervisors on Oct. 21, 1947. When the 42-bed hospital opened its doors on March 1, 1958, the emergency area — one room with two beds, manned by primary care physicians who were on call to care for their own patients — also opened.

By the late 1970s, the emergency department consisted of two trauma beds and five additional treatment rooms — including one specifically for pediatrics and one as an orthopedic room. The department was staffed by physicians contracted through a hospital physicians’ group. When the department was busy, additional patients were placed on gurneys in the hallway or in an adjacent empty storage room.

It soon became obvious that the emergency department, and the hospital, was bursting at the seams.

A three-story patient tower was added in 1985 to the main hospital, but it was not until 1994 when the emergency department was once again expanded to it’s present size — growing from seven to 18 treatment areas.

“We stayed in the old emergency [room] and built a new patient area,” said Donna Davis, director of emergency services. “When we moved into [the new area], they remodeled the old part.”
An additional expansion piece was completed later. Referred to as the Emergency Department Extension, it accommodates four additional beds, expanding the number of potential treatment areas in the emergency department to 22.

The current emergency department can have as many as 14 nurses and up to two doctors and a physicians’ assistant during their busiest hours.

But when patients are on gurneys, waiting to be admitted, the wait for a treatment area lengthens — because patients are being observed.

“That seems to be where the problem is. Every bed in the emergency room is monitored if they are being admitted for telemetry,” said Kathleen Widlund, vice president of patient care services. “If we could have an observation area where these patients could wait, it would help. But if two-thirds of our 18 beds are filled with patients waiting to be admitted, we start moving patients around. That’s when you start seeing patients in the hallways, but we can only move patients out of the emergency room as fast as patients are moved upstairs.”

Fortunately, the departments’ triage room, through their PIT — Provider in Triage — can also be used as a place to see a patient.

“Triage is a sorting process,” Davis said. “It begins as a patient enters — their first encounter [is] with the nurse.”

The nurse determines the level of the patient’s severity. Simultaneously, a physician’s assistant makes an assessment to see if the patient is stable. Many times X-rays and lab work are ordered and the patient returns to the emergency room lobby to wait.

“The patients love it because they are getting things done and moving through the process,” Davis said.

On minor cases, once the X-ray and lab results are in, the patient can return to the triage room, see a physician and be discharged from the triage room without ever setting foot into a treatment room. And, because the emergency department sees an average of 115 to 125 patients a day, being able to see and discharge a patient from the triage room is always a plus, Davis said.

Hospital officials said they thought they were set for a long time with their new size, but it was soon obvious that they were quickly outgrowing their area.

Expanding the emergency department is part of the facility master plan — for the future.
“Our most pressing issue is to relocate the lab,” Widlund said. “We have a plan in place but it’s a domino-effect type of thing. We are waiting for things to take place before moving forward.”

In the meantime, the emergency department expansion will have to wait, she said.
But that does not mean hospital officials are not concerned about efficiency.

Wanting to be proactive, the hospital contracted a consulting service, a physician from Texas with emergency room experience, to take an outside, objective-view of the emergency department’s efficiencies.

“He was here in 2004 so we thought it was time to bring him back, to see our efficiencies and see what we can do — see if he has any more tricks up his sleeve,” Widlund said. “This is all he does. He travels all over the nation, looking at emergency rooms and making suggestions on how they can run better.”

After spending three days in the emergency department — observing, and talking to doctors, nurses, technicians, phlebotomists and any other professional who might see a patient in, or interface with, the emergency department — the consulting physician will return in April with a review, findings and recommendations.

“Maybe we can put some of it into practice,” Widlund said. “We have sent him a lot of statistics for this. It would be good to see if he has something different to offer.”

Contact Esther Avila at 784-5000, Ext. 1045, or eavila@portervillerecorder.com.