By Helen Altonn
Star-Bulletin
The Queen's Medical Center's new emergency room wasn't on Ted Wilson's sightseeing list when he fell from a Waikiki reef and landed on his head while taking pictures.
But the 32-year-old visitor from Sacramento -- among the new ER's first patients -- said it was a "great" experience.
"It's really clean and quiet and the staff is super-friendly, very personable," he said after paramedics took him to the emergency room for treatment of head and facial lacerations.
The $14 million state-of-the-art ER opened for patients Nov. 17.
Moving from the 38-year-old ER to the new building wasn't simple, said Dr. Andy Schwartz, ER director, explaining it was like "getting married, having a kid and starting a new job -- a lot of changes."
The move was scheduled for 3 a.m. Nov. 17. The last patient was out of the old ER at 5 a.m., and by 5:30 a.m., Schwartz said, the new center was filled with patients."The place was booming," he said, noting that he joked, "They're going to have to build us a new ER."
The changes arepart of a plan to upgrade the 140-year-old medical center and provide a larger, friendlier, more efficient emergency room. The old one was designed for 17,000 patients annually and was averaging 27,000.
Schwartz said, "I think everyone was a little apprehensive going to work Wednesday (the 17th), not knowing what was going to happen."
"It's incredible. So many systems needed to function, many for the first time in our department, and things went very well," he said. "I have nothing but kudos for the project team, many of whom never earned a paycheck in ER" -- although they had input from the staff.
Now 21 private rooms
The new emergency treatment center is about 2 times the size of the old one. There's an increase from 18 to 30 patient beds and from three to 21 private rooms: 11 in the main ER, six in the psychiatric section and four in the Fast Track Section for patients with minor illnesses and injuries.The main ER handles trauma, critically ill and medical/surgical patients, with a capacity for up to six patients at once in the three trauma rooms.
Susan Orr, ER nurse manager who worked on the project for four years, said it was designed to decrease stress on patients and families, with soft colors, separate sections for different types of patients -- trauma, psychiatric, ambulance, police and walk-in -- and private rooms affording more confidentiality.
"We wanted to bring services to patients," she said, "so we have an X-ray in ER." Previously, she said, patients had to wait for someone to take them to the hospital's X-ray department, and then they had to wait for the X-ray and for someone to take them back to the ER.All lab work and X-rays are entered in a computerized tracking system, Orr said. "It lets us know how long they've been in ER, if the lab results are back, if a doctor has seen them and if they're being admitted (to the hospital).
"It gives us a real time picture of where the patient is in the system. We recognize the most frequent complaint patients have is length of stay or waiting time."
Registration at bedside
Instead of first sitting at a desk and giving someone insurance and other information, patients are seen by a nurse and taken directly to a bed if they have more than a minor illness, she said.The registrar goes to the bedside with a portable computer and registers them, she said. "Patients already are saying, 'You mean I don't have to go to another room to give information?' "
Schwartz said the computers are on wheels and are wireless, hooked up by infrared.
"Once you're in bed, the nurse, the doctor, the registrar -- anybody you need to see in the course of your visit -- can see you. It cuts down on a lot of wait, wait for registration, wait for a chart, wait for a room, wait for a doctor, wait to go to X-ray, wait to get an X-ray."
He said: "We really tried to create an environment where specialists can come down and do anything in ER that they would do in the office."
The ER also has high-tech communications, telemedicine and information systems.The ambulance entrance has a decontamination area with showers, a workstation and storage facilities for the Honolulu Police Department, Emergency Medical Services personnel and Queen's security department.
The staff still is adjusting and "finding new ways to do things every day," Orr said. Management is providing 24-hour coverage to solve any problems that come up, but there have been no major ones, she added.
"We've been working with the staff six to eight months, looking at role changes, how we wanted to flow the patient through the system," she said. "The guiding question is not what does the doctor or nurse want, but what is the best thing to do for the patient, and that got a little tough at times."
She said the ER's approximately 90 nurses and doctors, aides and secretaries spent a lot of time in training, doing dress rehearsals with some taking the patient's role.
"Patients have been telling us how beautiful it is, how nice and new it is. They like the private rooms ... the different approach to service that they see," Orr said.
The general waiting area for families has telephones, restrooms, a family counseling room and a keiki waiting area with a skylight, large saltwater aquarium and lots of toys.
The ground level of the building still is under construction for same-day surgery cases. Construction also is continuing on a 600-car parking structure on Miller Street and an ambulance dock, located over the tunnel entrance to the new public parking area.
When the parking garage is completed, cars will be able to drive across the grounds to the ER to drop off people, and then enter a tunnel to the garage.
Valet parking available
Meanwhile, Queen's security officers are directing traffic from 8:30 a.m. to 5 p.m. daily in the front campus area and they're monitoring the area around the clock.Valet parking also is available for people dropping off patients at the new ER from 8 a.m. to 10 p.m. Monday through Friday, and from 8 a.m. to 8 p.m. for patients entering and leaving the medical center through the main lobby.
"I hope people like it as much as we do," Orr said. "I think we'll probably be known as the most beautiful, nicest ER ever."