People lounge in recliners, watching big-screen televisions, reading magazines or sipping tea. Some people visit with a relative or friend, sitting with them in what could be any living room across the U.S.
While this scene of serenity does take place in the suburbs of Philadelphia, it also happens in what might be considered an unlikely setting the ED of Main Line Health Systems Riddle Hospital in Media, Pa.
More specifically, this is the Internal Dispersion Area of the Rapid Evaluation Unit within the hospitals ED. It is the final destination for low-acuity patients who come to Riddle for emergency care before returning home.
The REU is a new model for emergency care that virtually eliminates the wait for patients who typically would take a back seat to their critically ill counterparts. The new unit gets these patients in front of practitioners quickly and the main ED is kept open for patients requiring more intensive care.
Patient experience was at the heart of this innovation, spearheaded by Donna Cantalupi, RN, MSN, CCRN, NE-BC, nurse manager of Riddles ED. The motivation for designing the REU, said Cantalupi, was to keep patients out of the most dangerous room in the hospital the ED waiting room.
Work in the REU is high speed; its a high turnover, said staff nurse Shawn Cassidy, RN, who works in either the main ED or the REU, depending on the day. But, then again the acuity level is much higher in the main ED.
Cassidy, a commander in the Navy Reserves, was in Kandahar, Afghanistan, when the idea for the REU was developed. He came home to the newly constructed unit and immediately noticed a difference.
We give quicker, more efficient care, he said. The wait times have been cut in half. Everything is immediate.
A little more than a year ago, the wait times for non-critically ill patients were between two and three hours. That was before Cantalupi, the ED nurse educator, the ED physician campus chief and four members of the ED nursing staff put their heads together to design the REU.
The community around here outgrew our ER, Cassidy said. We were pushing maximum capacity every day.
Cantalupi described days where patients would be literally spilling out of the ED, on beds in hallways, overwhelming staff and frustrating already-uncomfortable patients.
Today, if a patient waits even 30 minutes, Cantalupi gets nervous.
Theres a desk with a registrar where we do a mini-reg: wristband, demographic inquiries, complaint, she said. Then, as long as the units six beds are not full, the patient is taken right into the REU.
The care team comes to the patients bedside all at once. This spares the patient from having to repeat the reason for coming to the ED to multiple people, Cantalupi explained.
While the tech takes the patients vital signs, the physician discusses a plan of care. If the patient is deemed stable, the nurse leads the way to the Internal Dispersion Area, where the patient stays until test results return, the prescribed observation time expires or paperwork is completed prior to discharge. All the while, a nurse or physician is nearby, ready to provide any care that is required.
This is a care model that I have never experienced before. I was intrigued, said staff nurse Cecilia Carpenter, RN, BSN, CEN, a nine-year veteran of emergency nursing who was among those hired to staff the new unit when it opened in July 2012. Its been really nice to see the impact on the way patients move through the ED. They come right in, they see a care team. They get their treatment immediately, and unless they need testing done, they get out quickly.
Patients are very vocal about it. Patients love it.
The REU soon will undergo significant changes, Cantalupi said. In the next phase of construction, the six-bed REU will be demolished and a new radiology room, staff lounge and work space will be added. The Internal Dispersion Area will be expanded. The new REU will boast eight private rooms. In the final phases of construction, the main ED will be remodeled, one half at a time. The entire project is expected to be complete by October 2014.
Throughout the entire five-phase, three-year construction project, Cantalupi stays focused on what matters most. We dont want to interfere with the REU and that process, because its worked too well for us, she said. We dont want patients to lose faith in that.