Mary Castillo Patients of the South Coast...

Mary Castillo

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

cardiac patient.

“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

communicate.

“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

said.

“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

outflow.

“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,”

Taub said.

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

person’s life.

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

patients.

“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.