Stony Brook ER frontrunner in overcrowding solutions

By DEBORAH A. MILES
In early October, NBC Nightly News ran a special segment on overcrowding in hospital emergency rooms. When ER’s have nowhere to put patients, it’s called “boarding.” They end up in hallways, cubicles, anywhere there is space. Some even die because they are not seen in time.

But Stony Brook University Medical Center on Long Island stood out among the crowd.
The segment ended with hope, showing how Stony Brook has reduced the ER waiting room burden by transporting patients directly to certain floors where their medical needs can be met.

Valerie Sayage, an ER nurse at Stony Brook and PEF Division 225 member, is well aware of the increase of patients and the problems that poses.

“Our ER sees about 220 people per day,” Sayage said. “That average is trending up.”

Having a program in place in the ER to safely move patients to another floor using specific guidelines gives the patient increased accessibility to physicians and nurses, continuity of care and privacy, according to Sayage.

Unlike the emergency rooms shown on the NBC broadcast where a 49-year-old woman was brought to a Chicago hospital with chest pains and, after waiting two hours to be seen, died of a heart attack, Sayage said that scenario is unlikely to happen at the Stony Brook ER.

“In our ER, patients who are very sick, who are dying, who have had a stroke or worse are seen immediately. These patients don’t wait,” she said. “Other patients who are less ill are seen as timely as humanly possible.”

Moving to another floor
“We take patients from the ER,” said Jennifer Toscano, a floor nurse at Stony Brook on 16th North.
“We have been getting more and more hallway patients in order to move patients out of the emergency room. Instead of sitting in the ER, they have a home.

“They also have a nurse who is not transitioning every four hours, so the experience of being on a regular floor brings a level of stability,” Toscano said.

On the 16th floor, which is known as a “medicine floor,” all types of patients are accepted.

“We take patients with gastrointestinal, neurological and respiratory issues. There’s no special criteria they have to meet. Patients are placed based on acuity,” Toscano said.

“On a medicine floor, one nurse has six or seven patients, whereas on other floors, there are fewer patients per nurse.”

Nanci McLaughlin, another nurse and PEF member at Stony Brook, said the system is in place to move patients out of the ER quickly.

“ER is always busy, and patients just feel better getting out of there. We’ve had some hallway patients on our floor. The physicians are more accessible to them and they have nursing staff readily available,” McLaughlin said.

Hallway patients are provided with call bells and also have privacy screens.

The bigger picture
“The bigger problem is more and more people are getting sick, I mean really sick and unable to be safely discharged back to their own homes,” Sayage said. “This results in longer hospital stays and less bed availability.

“We are the only tertiary care facility in Suffolk County. We are seeing a higher acuity of patients and a higher volume of patients. It would be ideal for more beds to be created,” Sayage said.

“As far as the nationwide problem, that’s another nut to crack.