Caroline Castellino

From Emergency Room of the Future
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I am a Masters Student in the Health Systems Institute, and I received my undergrad degree from GT in Biomedical Engineering. I love to read, travel, and talk and learn about environmental issues... particularly love this site: treehugger


From working and observing at Children's Healthcare of Atlanta, I think that when a patient first comes i they register, are sorted and may go through to a fast track area. Or they may go to a central waiting room. Then they see a nurse, are placed in a patient room, and eventually a doctor arrives to see them. They may need to leave for lab or radiology tests. They are not always admitted and may sometimes be discharged directly after being initially evaluated.

Today I learned that in the ED there is a delay not only because of a possible increase in patients, but also because patients cannot move from ED beds to beds in other units since those units may also be full. This just keeps pushing the problem farther back. Since such a variety of patients come to the ED, I wonder how much more intensive and longer the training is for ED doctors than those in other specialties.


For the ED Tour I will be interested in seeing how patients move through the process of registering, waiting, seeing the nurse, doctor, and being discharged. I will be paying extra attention to how often the patient and clinician is moving around, to see if that movement can be reduced by redesigning the units and/or rooms.


I took several pages of notes during the ED tour of Emory Crawford Long today, and some of the main points are below.
- There are 5 family waiting rooms
- Patients normally come in and go to triage (4 rooms)
- One triage room has a window so the nurse can see through to the waiting room
- Patients are assigned a level of 1 through 5, with 1 being the most severe
- If the ED is full, patients in the waiting room are given standing orders (ie. start IV, blood tests, etc.)
- Express Care is usually for level 4 and 5 patients, and sometimes they help out with the Acute Care
- The Clinical Decision Unit (CDU) is primarily for observation of patients; one family member can stay in the patient room overnight
- The CDU frees up space in acute care
- Some problems I noted were that the MDs don't always have access to the Pyxis machines in the CDU; there were ventilators and trashcans in the hallway
- The nurse told us that the biggest problem is patient education; patients need to know what constitutes an emergency; the wait time is the main complaint; RNs and MDs could be more efficient to move patients through the system more quickly