Patients of the South Coast Medical Center say the hospital is
doing the ER right.
The California Emergency Physicians Medical Group recognized the
medical center’s Emergency Department for ranking number one in
patient satisfaction. The award is based on findings from a quarterly
patient survey, singling out the hospital among 41 other
CEP-affiliated ERs across California.
It’s a pretty impressive distinction considering that anyone who
has visited an ER knows patients aren’t typically in a happy frame of
mind. But when you walk through the front door at South Coast Medical
Center ER one of the things you notice is the tranquil sound of a
vertical water fountain across from the check-in window. Wildlife
paintings by local artist Chris Hoy brighten the walls and activity
tables and books wait for little hands.
Unlike TV ERs there are no maverick doctors taking extraordinary
risks to save a patient or nurses sleeping in unoccupied beds during
a 36-hour shift. In fact sitting down with Dr. Marc Taub, medical
director of emergency services, one would never know that behind
those automatic doors the care team is fighting to save the life of a
“At any given moment we can have one patient or 12 at the same
time,” he said. “The team concept allows us to manage many patients
at once and we’re prepared to handle a person with a stubbed toe or
someone suffering from a massive heart attack.”
The core care team is comprised of a physician, two registered
nurses, a licensed vocational nurse and two EMTs. The teams work
eight-to 10-hour shifts, providing around-the-clock coverage.
“We schedule in a way so that staff is rested,” Taub said, citing
that most private hospitals -- unlike their TV counterparts -- are
moving toward wellness-friendly scheduling. “Thirty-six hour shifts
are not safe for patients.”
On any given day the team takes care of 40 to 50 patients for
beach injuries, flu, colds, heart attacks and strokes. Walk-in
patients typically wait only 22 minutes to see a nurse from the
moment they check-in -- half the national average wait time for ER
departments across the county. The goal of the department, said Taub,
is to keep the waiting room empty and get patients to the triage room
and then to a bed so they can begin receiving care. The average time
a patient will spend in the ER is an hour and a half. The hospital
achieved that level of efficiency after the ER teams underwent
training similar to the way Army helicopter pilots are trained to
“We communicate, coordinate and maintain a safe environment as a
team,” he said.
All team members must check back or repeat an order verbatim as
they work on a patient. Also, members are empowered to challenge each
other’s decisions to ensure that a patient receives safe care.
Taub said that when the team functions it allows them to make a
difference in the lives of all the patients who come through. But
team work isn’t just exclusive to the ER. Last year, South Coast
Medical Center created a team-within-a-team approach to an emerging
crisis of overwhelmed ERs turning away ambulances. In order to create
a system that would allow the ER’s doors to remain open 24-7, the
hospital instituted an operations notification system.
There are three levels of operation for the ER. Level one is
normal, level two signals more patients and level three is diversion.
But when the ER reaches level two, a hospital-wide announcement goes
over the P.A. calling for available staff to lend a hand before they
get swamped. Even when the ER is on level three, they will not turn
away walk-in patients or extremely critical ambulance patients, Taub
“We have a good family down here,” Busby added. “Supervisors and
people from all parts of the hospital come down to help.”
The one thing that they cannot control is when nearby hospitals go
on diversion and it creates a domino effect that can stop up South
Coast Medical Center.
“We spend about 10 hours a month on diversion,” Taub explained.
“Last year we were 70 to 80 hours.”
However, the team’s strict regimen of morning briefings and
periodic board rounds allow them greater control of patient in and
“First thing in the morning we figure out which patients are in
the ER, make sure they get adequate beds, become familiar with
specialists on call for the day and get status of local hospitals,”
Board rounds allow the care team throughout the day to re-group
and re-prioritize after an intense influx of patients or just to keep
track of what is happening. Inside the double doors, past the triage
room and two patient rooms, the care team prepares for a board round.
The atmosphere is just calming down after the team stabilized a
cardiac patient who was earlier flown out of Mission Hospital.
Someone sweeps away the evidence of feverish efforts to save that
South Coast Medical Center does not perform interventional cardiac
procedures such as angioplasties, putting in a stent or open-heart
surgeries. However, they have the expertise to receive and stabilize
“We’re a very good cardiac receiving center,” said Debbie Busby,
supervisor of nursing administration and an admitted adrenaline
junkie who has been with the hospital for 10 years.
Physicians and nurses alike have to be quick on their feet and
make split-second decisions. When the ER is running full speed ahead,
nurses must juggle multiple patients with a variety of ailments
ranging from minor to severe. Obviously it takes a special breed of
person to handle this kind of pressure day in and day out.
“In the ER you never know what you’re going to get,” Busby said.
“You have to remember that you have a life outside work and you do
the best you can when you’re here.”
Although these individuals appear to function at the speed of
light, their compassion can be a challenge when faced with a patient
who is so close to the end or a patient who has ended up on the
stretcher because of unnecessary violence or tragedy.
“When someone presents a critical situation you have to do what
you can to help them,” said Joni Taylor, director of emergency
services at the hospital for 12 years.
The hospital provides staff who can lend emotional support to
anxious families in the waiting room, but the minds of the care team
are solely focused on the physical needs in the center of a crisis.
“Afterwards it can be hard,” Taylor admitted. “Sometimes you can
cry on the way home but you find strength because you have the skills
that can help those patients.”
* MARY A. CASTILLO is a news assistant for the Coastline Pilot.
She covers education, public safety and City Hall.