Life in the ER


We all think we know what life in the ER is like from watching television – a chaos of bleeding patients or those needing to be shocked back to life, and physicians shouting orders to harried nurses while paramedics crash gurneys through swinging doors. While most real-life emergencies can be as dramatic, on most days life in the ER is filled with the challenges of the vast range of conditions that present in 24-hour-a-day, non-stop emergency medicine.

St. Joseph’s Healthcare is the busiest ER in Hamilton with close to 50,000 visits annually. Emergency department staff can face everything from car or sports injuries, through broken bones and burns, uncontrolled bleeding and chest pains, difficulty in breathing and stroke, overdoses and suicidal/homicidal thoughts, severe allergic reactions to complications from diseases and fever. No other department sees that variety of conditions.

To meet that need SJHH has expanded the Emergency Department from 13,392 to 22,376 square feet. The new ER includes new state-of-the-art equipment, larger private exam bays, four full isolation rooms with anterooms, plus a segregated isolation area with five rooms.

Isabel Hayward, administration director for Emergency and Urgent Care Services at SJHH, says, “We’ll be the envy of other hospitals because there will be no patients in hallways. Patients are placed in the new bays allowing for better confidentiality – for privacy and quiet.”

Emergency Department patients are first assessed in the Triage area where decisions are made based upon the severity and acuity of each case. After assessment Quick Care patients are treated and discharged. The more critical patient is admitted to the Critical Care area where they can be monitored with state-of-the-art equipment. The Observation area provides immediate care for patients presenting with more complex complaints. These patients require a longer length of stay and most require admission to hospital.

An emergency physician examines all children who come to the ER at St. Joseph’s. If necessary, a referral is made to a pediatrician who will consult on the needs of the child and parent. In the new, expanded ER the area designated for the care of pediatric patients provides a family environment that allows children to be separated from the sights and sounds and commotion of a downtown urban emergency waiting room.

There is also an area for Emergency Psychiatric Assessment. The team of the unit work collaboratively with the staff in ER to support and care for patients in crisis.

“Emergency Departments have a great role to play in the health-care system,” says Hayward. “Right now we provide not only emergency care, but a lot of primary care for our clients. Patients also present themselves here because they know they can get quicker access to services. With the shortage of many specialties, we are playing a very necessary role. Part of our role is to assist patients with providing them with the required resources to access in the community, as well as educating our patients in order to assist them in successfully managing their illnesses.”

Emergency physicians, trained emergency nurses, and social workers make up the team of Emergency professionals available at SJHH. Jane Jennings, a new member of the St. Joseph’s ER, has a role that is on the cutting-edge of emergency care.

Jennings, a nurse with over 20-years of experience, is taking on the role of a Geriatric Emergency Management Nurse. She is a Primary Health Care Nurse Practitioner who will assess, order diagnostic tests, diagnose, and prescribe without the supervision of a doctor. She will work in collaboration with the physician and the multidisciplinary team to provide the appropriate plan of care for the frail elder population in the ER.

Geriatric Emergency Management is a project funded by the MOH LTC, in association with the Regional Geriatrics Programs. The Ministry targeted the funding to eight of the most active ERs in Ontario with the goal of developing a program that best serves the frail seniors in emergency and builds capacity in the existing system to enhance the continuity of care.

“At St. Joseph’s Healthcare ER the senior population comprises approximately 15 per cent of the total number of patients assessed,” says Jennings. “Statistics indicate that they utilize a greater number of ER services than younger individuals, have a longer length of stay, and require more diagnostic and staff resources. My role is an opportunity to proactively implement preventive measures for patients who are 75 years and older.”

Isabel Hayward is proud of her staff. “We are very fortunate. Our staff is great and had a lot of input into the design of our new ER. St. Joseph’s has wonderful leadership, emergency physicians and nursing staff. Combined we have a lot of experienced staff who truly want to look at participating in decisions and looking at the best possible care that we can provide. And I know that whenever there is an issue that is important to patients they will be at the table looking at how we can do things better.”

It takes a special kind of health-care giver to work in the emergency department of a hospital. Each member plays a vital role in providing expert and immediate attention to patients, and timing could mean the difference between life and death. Pressure and stress are high.

“You have to be a very caring person, but you also need the balance of not letting it get in the way of some of the difficult things that you are seeing or some of the difficult things you have to do,” says Hayward. “You need a high skill-set and a broad knowledge base. To work in ER you need to be an independent thinker that can piece together facts and integrate them into the best outcome for the patient. And you also have to have what ER nurses call ‘the gut’ – a knowledge and instinct that develops after dealing with so much.”