November 15, 2019

Tim Layman: A Visit to Highlands-Cashiers Hospital’s Emergency Room: What You See, and What You Don’t

By Timothy Layman
Interim Chief Executive Officer/Chief Nursing Officer, Highlands-Cashiers Hospital

This month I thought it would be exciting to pull back the curtain, so to speak, on what goes on once you enter Highlands-Cashiers Hospital’s Emergency Department. There are all the things that you, as a patient or family member of a patient, see and hear, but there are many things that our caregivers and other staff do that are much less obvious, but essential nonetheless. This information also serves to explain the average amount of time that an emergency visit requires, something we are continually assessing.

The ED is a complicated place with multifaceted treatments for each patient, and varying responsibilities, depending on whether you are a nurse, technician, general practitioner, or specialty physician. You probably know that we initially prioritize patients by determining whose needs are most urgent; this is called triage care. Here’s an example – if a person comes into the ED with a sprained ankle and another arrives from a car accident, we would need to access and treat the person in the car accident first. The reason for this is based on unknown injuries that could be life-threatening vs. the known sprained ankle.

I’ll create a hypothetical example of a male teen, brought to our ED by his parents, who has experienced a sudden-onset, severe headache. Our first concern would be a stroke, and although a teenager is an atypical stroke victim, we must first address the gravest possibility – even if it is unlikely.

We’ll call our imaginary patient “Wylie.” When his family enters our ED, we have to register him as a patient and communicate with him and his parents about his history of pain and any other symptoms he might be experiencing. Then we need to start ruling things out and entering into a deductive process. For example, we’d need to perform bloodwork, an MRI, an NIHSS (National Institutes of Health Stroke Scale) assessment, and other exams to rule out stroke.

Another critical part of our treatment, simple though it may sound, is communication. We need to listen to our patients from the moment they enter our ED; then, as they begin their journey with us, we continue to listen – even for the things they might not be saying. Then we need to observe them continuously and respond accordingly to whether their condition is stable or rapidly changing. Next, communication needs to be crystal clear among the members of Wylie’s care team so that each knows they are dealing with the most current record of what interventions Wylie has received. Last but certainly not least, we are bound to provide understandable, frequent updates to the parents. All of these interactions influence a patient’s and family’s experience profoundly.

Treatment that may not be evident to patients and families, but that happens without exception, includes a variety of screenings on every patient. We screen for physical abuse, mental health needs, well-child norms, and care needs, etc. What went on in our ED just when Wylie and his parents arrived also factors into his care.

If, after his testing is completed, he requires an ED bed, we must make sure the nursing staff has thoroughly cleaned the space he will occupy since it was used to care for the patient that immediately preceded Wylie.

These are just some of the intricacies that go into making our ED operate effectively and successfully, but many are “under the radar” as patients wait for treatment and information. At times, one patient may require the services of two nurses. Not only that, but the initial acuity presentation may increase or decrease accordingly.

It’s tempting to think that there’s a “magic” solution when it comes to speeding up ED care, but as you can see, each patient’s time-to-treatment period is influenced by so many co-occurring realities. I’m proud to say that Wylie’s – and everyone else’s treatment – is completely personalized when they visit our ED. One patient’s more extensive experience is made up of many smaller ones that are frequently in flux. We’re called upon to be resourceful as patients’ needs change, and I hope this window into our world is both revealing and helpful to you as healthcare consumers.

We continue our search for physician candidates for Cashiers and hope to have news in the coming months as to who will be joining us to provide exemplary care for the Cashiers community.

Timothy Layman, DNP, is the Interim Chief Executive Officer and Chief Nursing Officer (CNO) of Highlands-Cashiers Hospital. Layman holds a PhD in Nursing Practice from Yale University, a MS in Nursing Administration from LaRoche College and a BS in Nursing from Pennsylvania State University. Before coming to Angel Medical Center and Mission Health, he served as Vice President for Innovation and Entrepreneurship at Thomas Jefferson University. Layman currently serves on the faculty of Thomas Jefferson University and Yale University.