ERs Serve on Frontlines of Health Care

YOUNGSTOWN – The pop culture image of an emergency room is a far cry from reality. Once one of the most popular shows on TV in the early 2000s, “Trauma: Life in the E.R.” depicted emergency departments as a constant stream of victims of shootings, patients who had overdosed and those with other bloody accidents.

“The reality is those shows are compilations of weeks of filming. No different than any other experience. The day-to-day in an emergency department is generally associated with evaluating patients and discharging them home,” says the president of Mercy Health-Youngstown, Dr. John Luellen, who spent much of his career in the emergency department. “It’s unusual, or less common, for them to be admitted to a hospital.”

It’s uncommon, he says, for emergency medical staff to need the maximum level of their skills. The most common reason someone visits the ER is dental pain. And treatment in such a setting is among the most costly because the department must always be prepared for the most life-threatening issues.

By law, emergency departments aren’t allowed to turn patients away. Often, there are places better suited to treat them. It’s an issue that spotlights the drive of health-care providers to improve access.

“An emergency isn’t always just an illness or injury. A lot of times, it’s also, ‘I have this concern but I don’t have access. I know what’s wrong, but I don’t have anywhere else to go,’” says Dr. Robert Moosally, medical director of the emergency department at Trumbull Regional Medical Center. “We need to treat those presentations with the same critical thinking and urgency as we would someone who comes in short of breath with pneumonia or a broken limb.”

By being connected to the hospital and all the care options within, the ER at Trumbull Regional can serve as the first step to getting that care. And with the $1.63 million expansion underway, patients will be able to receive more streamlined care and an expanded suite of services in the department.

The first portion of the three-phase project, expected to be ready by summer, will expand the size of the ER and add an area dedicated to behavioral health patients. That space includes five beds in an area away from the main ER and dedicated staff who specialize in behavioral health.

“We need to make sure they’re in the right setting to get the right care with the right specialty attention,” Moosally says.

Since the coronavirus pandemic began, emergency rooms across the country have seen a decline in the number of patients who come through their doors, a phenomenon often attributed to patients delaying care because of concerns over the safety of hospitals.

“In some cases, these medical conditions progressed due to a delay in seeking treatment,” says Dr. Anita Hackstedde, president and CEO of Salem Regional Medical Center. “Obtaining timely care is especially important for those experiencing a stroke or heart attack, since outcomes for these medical emergencies are strongly tied to how quickly a person receives treatment.”  

As the year progressed, Salem Regional saw an uptick in patients seeking other avenues of care for less acute health problems, she adds, including telehealth and clinical sites.

From a logistics standpoint, adapting ERs to the requirements of the pandemic was a challenge. They’re limited by their physical space, have a finite amount of properly trained staff and can’t be “turned down or turned off,” Mercy’s Luellen explains.

“It’s very different than what exists in an office. If staff become ill, you can close the office for 10 days. You can’t do that at an emergency department,” he says. “The solutions had to be creative and it’s something we still struggle with from time to time. Because emergency department volume isn’t always predictable, there are surges when it becomes an issue.”

At Trumbull Regional, the hospital added a trailer outside its emergency department that served as both a COVID testing space and an overflow area for the main space when demand peaked.

“It gives us extra space to care for patients in an area that’s designated for certain complaints,” Moosally says.

The pandemic also forced medical providers to examine almost every facet of their operations. Once the pandemic is under control and life returns to normal, waiting room chairs will be closer together and fewer people will be wearing masks. But there will certainly be permanent changes.

The past year has forced hospitals to “take a step back and objectively decide what we were doing well and what we need to improve on,” Moosally continues. At Trumbull Regional, even things as simple as moving a patient from one part of the hospital to another – a mundane task that health care workers may perform countless times – were examined.

“There was no room for ambiguity in decision making. We had to be critical of ourselves,” he says.

Hackstedde says the changes to the use of protective equipment and sanitization procedures will stick around throughout the Salem Regional system.

“Our top priority is the well-being of our patients and staff. We have taken every safeguard so our patients can feel comfortable receiving the medical attention they need,” she says. “Enhanced safety measures are here to stay so that our emergency department can fulfill its core purpose: rapidly assessing, stabilizing and treating patients.”

Whatever that health issue may be, the physicians agree that patients often define for themselves what qualifies as an emergency. Because of that, Moosally says, there’s special care that emergency medical staff take with them.

“In my career, I’ve trained a lot of residents and other doctors. I always try to impress upon them that they need to keep an open mind about what the emergency is,” he says. “I’ve never assumed to be in a position to decide what’s serious enough for you to come [to an ER]. I’m here to evaluate and direct you to the right place. I’d never discount concerns.”

Pictured: Trumbull Regional Medical Center is in the midst of a $1.63 million upgrade to its emergency department.