29 Sep: Monday - Emory John's Creek ED visit

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Emory John's Creek ED visit

The tour of John's Creek Emergency Department was the polar opposite of Crawford Long’s Emergency Department. ER Nurse, Mick led us through the ER and described the process in which patients were admitted, triaged, and cared for during a typical ER visit. The following bullets list my observations.

1. I first noticed that no one was in the waiting room. In fact, as the tour progressed we only saw two patients. There were 10 total patients at the ER but John's Creek does not use hallway beds and all of the patients were in their rooms.

2. The entrance to the ER for drive-in patients is separate from the EMS entrance. The drive-in entrance had wheelchairs placed at the entrance which allows patients to have quick access. The ER staff even placed the wheelchairs in such a way that it was easier to manuever (patient centered).

3. The waiting room was clean and had a warm feel unlike many other ERs I have visited. The facility is fairly new and is well decorated. There is a room for children to play in that will not disturb patients waiting for treatment.

4. The check-in counter was unmanned at the time we entered and was very bulky. If the clerk was sitting down it would be hard for them to see patients as they entered the ER. There was also three registration booths which were not being used because of EMTALA - Emergency Medical Treatment and Active Labor Act[1].

5. Triage was conducted in one room. The room was, large rectangular shaped, had plenty of space and all of the medical equipment neccessary but was not efficient. The Triage area was Mick's being issue with the ER. He stated that the room does not allow the triage nurse to patients as they enter the ER. The room can only be used by one patient which sometimes delays triage if the patient needs an EKG (10 minute test). The room had a lot of space (a stretcher, chair for the patient, chair for family, desk/workspace for nurse, and a large open area) that was not used during most triages.

6. The ER was shaped like a U with the nursing station in the center at the bottom. This allowed the ER staff to see most of the ER rooms. However the nursing staff could not see down the hallway. The utility rooms were not located near each other so a nurse would have to walk to several ends of the ER to get supplies, medicine, and deposit soiled linen.

7. The supply area, a recent LEAN project, was extremely organized and was centered around the nursing staffs' needs. The supplies were grouped by medical treatment process as opposed to alphabetical or by stocking needs. There was a scanner and computer to enter barcodes for patient billing purposes and restocking inventories. The bins were color coded and there was plenty of space for several nurses to retrieve supplies without getting in the way.

8. The EMS breakroom was stocked with snacks, sandwiches, drinks, and a small TV. Mick would like to provide more space for EMS so that they want to bring patients to John's Creek.

9. Patient treatment rooms were large enough for one or two family members and had a small flat screen TV. The compter in the room was wall mounted and locked in a cabinet. The computer cabinet swings out so the doctor can enter data and see the patient at the same time.

10. The discharge/checkout area was not staffed when we walked by. Mick tested the bell and it took 2 minutes for someone to respond. They have had several patients just walk out of the ER without paying. (This could be fixed by having a nurse escort patients to the checkout area - could say it was safety issue and a nurse was required to escort the patient while in the ER).

    Overall John's Creek ER was very quiet, nicely decorated, and efficient.  The triage area needs to be redesigned to allow for more than one triage and the checkout area needs some attention.