New ER offers Rx for better care

For somebody who’s spent more than 20 years on the frontlines of life-and-death medicine, Johnnie Holmes was looking a lot like a kid in a candy store.

Holmes, a supervising charge nurse in the emergency room of Olive View-UCLA Medical Center, was breezing through the halls and treatment rooms of her new workplace this week and searching for adjectives to describe it all.

“Amazing,” “exciting” and “incredible” were all getting a workout.

After working in extremely cramped quarters to care for patients suffering from everything from gunshot wounds to gallstones, Holmes and her crew are about to start nursin’ large.

As in 31,000 square feet large—more than double the size of Olive View’s old emergency room.            `

The new ER, unveiled at a ribbon-cutting ceremony on Monday, will begin serving patients on March 6.

Its 51 treatment areas include two “trauma/procedure rooms” for the sickest patients, seven rooms for cardiac patients and specialized rooms for obstetric-gynecological exams, eye problems and orthopedic needs.

The facility also features a separate isolation ward for patients with tuberculosis and other infectious diseases, as well as, potentially, victims of a bioterror attack.

In the new ER, tests such as CT scans, ultrasounds and basic lab work will all be done onsite, so patients won’t have to be transported across the hospital for such workups.

The ER’s gleaming new equipment includes a device called VeinViewer Vision, which uses light and digital imaging to allow nurses to, in effect, look through a patient’s skin to find a vein to insert an IV or to draw blood.

“This is an amazing machine,” Holmes said as she demonstrated the VeinViewer for visitors.

But it will take more than new technology to confront some of the ER’s biggest challenges. The ER’s patient load has grown by 15% over the past two recession-plagued years, from 40,000 patients to 46,000. That mirrors a trend seen in emergency rooms across the county recently, with high unemployment and people losing their health insurance.

A related issue is that Olive View’s ER, like other emergency rooms, has long waiting times–a problem the hospital has been working to address, with some success, even before the move to the new ER.

In the past 12 months, median wait times in Olive View’s emergency area dropped from just under three hours to just under two hours, despite the increased patient load, thanks to the addition of a physician to perform rapid medical screening exams. The overall length of stay for patients dropped from eight hours to seven. (Similar efforts to make sure the sickest patients are treated first are underway at other county facilities as well.)

In hopes of continued improvement, Olive View officials are planning to add another nurse practitioner and to increase the physician staffing in the ER in the next four months, and have also hired a consultant to look at patient flow and staffing issues in the new space. They expect that greater efficiencies will come from having onsite labs and radiology, as well as a chest pain observation area and more versatile exam rooms and monitoring equipment.

Olive View is only public hospital serving the San Fernando, Santa Clarita and Antelope valleys, and is a key part of the county’s overall emergency services network. The new ER should allow Olive View to serve from 8,000 to 10,000 more emergency patients each year. The $53 million project, which started in 2002, finished nearly $1 million under budget and nine months early.

That’s good news for patients, who in addition to the long waits have gone without privacy and even beds, being treated in chairs or crammed into hallways on gurneys.

“We have the most incredible patients,” Holmes said. The new ER “is going to be less stressful for us and hopefully a lot less stressful for them.”

“You find yourself apologizing all the time,” she said. “All of the nurses go home with bruises on their thighs because they’re always running into gurneys. It will be amazing to have all that space.”

Holmes, 61, who worked for the folk rock duo Seals & Crofts (“Summer Breeze”) before becoming a nurse, now acts as a kind of air traffic controller in the ER, making sure the most urgent cases are seen first. In preparation for the new ER, she staged a scavenger hunt (with See’s truffles as prizes) to help nurses learn their way around the vastly larger space.

“It’s like a dream come true for all of us,” she said, even though she expects some “separation anxiety” among nurses who’ll be shifting from a single nursing station in the old ER to seven in the new space.

She said that–with the notable exception of the waiting times–public hospital emergency rooms provide care that equals or exceeds that offered in many private facilities.

“It always amazes me that people have a tendency to put down public hospitals. I’m here to tell you that, after being in private emergency rooms with my family members…they give the most amazing care here.”

The new emergency room is “first class,” said Supervisor Zev Yaroslavsky, who represented the Board of Supervisors at the inaugural event along with Supervisor Michael D. Antonovich. “The only thing missing right now is patients.”

Before the ribbon was cut, Dr. David Talan, chief of the hospital’s emergency medicine department, gave a shout-out to those patients. “Thank you for your trust. It’s an honor to help you…Above all else, the new Olive View emergency room is for our community and all of the people we are dedicated to serving.”

Talan also saluted his emergency department staff. “They’re here after everyone else goes home,” he said. “They have been doing their best under some very challenging circumstances.”

Posted 2/16/11