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The BWH Emergency Department cares for 50,000 patients per year in
three contiguous areas: Acute, Urgent and Fast Track. Twenty five
percent of patients seen in the Emergency Department are admitted,
accounting for about thirty percent of hospital admissions. The Observation
Unit cares for patients requiring further diagnosis or treatment beyond
the normal emergency visit. The Observation Unit sees approximately
3,000 patients per year and is staffed by registered nurses (most
of whom are Certified Emergency Nurses) and physicians, all of whom
are Board Certified in Emergency Medicine.
Residents from Emergency Medicine, Internal Medicine, Surgery and
OB-GYN are assigned to see patients primarily in the department as
part of a month long rotation. Residents from these and other services
come to the department to see patients in consultation and to admit
them to their respective services. Consulting residents must discuss
their recommendations with the attending Emergency Medicine physician.
Patients should be seen within ten minutes of being placed in a room.
Every patient must be signed out with the attending physician. The
patient’s primary physician should be notified of the patient’s
visit, usually at the time of the disposition decision; other specialists
involved in the patient’s care should also be notified (documentation
of the notification is necessary). Any patient requiring prolonged
(over four hours) diagnostic evaluation or extended treatment should
be transferred to the Emergency Observation Unit.
MGH
The Emergency Department (ED) at MGH is a full-service, state-of-the-art
facility that provides care to greater than 73,000 patients annually.
It is a high volume, high acuity level-1 trauma center (adult, pediatric
and burn) with an admission rate upwards of 28% (including both inpatient
and observation admissions). The ED is staffed 24 hours/day by attending
emergency physicians who are responsible for all care in the ED and
supervise residents and students. The department is chaired by Dr.
Alasdair Conn and all attendings are Harvard Medical School faculty
members.
The ED is geographically divided by level of acuity into treatment
pods. Trauma/Acute is a 10-bed unit designed to manage the highest
acuity patients. Major Multipurpose (MAMP), designed for medium acuity
patients, is a 17-bed unit including a seclusion room and a gynecology
exam room. Minor Multipurpose (MIMP) is the MGH version of a fast-track
unit for low acuity patients. There is a 7-bed Rapid Diagnostic Unit
(RDU) designed to provide rapid treatment and disposition for patients
with specific chief complaints.
Children are seen primarily in the pediatric area of the ED and sub-acute
psychiatric patients are seen in the adjacent Acute Psychiatric Service
(APS) clinic.
Emergency radiology services are provided by the Division of Emergency
Radiology and are located within the ED. Interpretation is provided
by onsite Radiology attendings, fellows and residents.
House Officer coverage in the ED is provided by residents in the Harvard
Affiliated Emergency Medicine (EM) Residency. Residents from Surgery,
Medicine, Pediatrics and Neurology are assigned to ED rotations. All
other services are available by consultation. For those patients requiring
admission to MGH—regardless of the admitting service—it
is important that the patient's primary care provider (PCP) be notified
at the time of admission. In addition, PCPs of ED patients who are
discharged (excluding MIMP patients) should also be notified by the
responsible House Officer. No patient discharge may take place without
the knowledge and assent of the ED attending physician.
Documentation of each patient’s ED visit is a required part of
emergency care and should be in compliance with Health Care Financing
Administration (HCFA) guidelines. No patient should be sent home without
proper discharge instructions, which at a minimum should include what
to return for, what medications/treatments to take and when and with
whom to follow up. Make certain to communicate not only with the patient
but also with close family at the patient’s request, but also
keep in mind issues of patient confidentiality.
ED overcrowding is an ongoing issue at MGH and it is imperative that
all services cooperate and combine their resources to improve ED throughput.
Otherwise, the ED fills up and goes on "ambulance divert"—which
is unacceptable to all services. Tests that can be safely done after
the patient is admitted or on an out-patient basis should be deferred
in the ED.
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