UNM Hospital’s Department of Emergency Medicine has implemented a new program aimed at improving the care of critically sick and injured patients.
The Emergency Department Resuscitation Unit (EDRU) is bringing best critical care practices, procedures and protocols – the kind of highly specialized care found in UNMH’s intensive care units – to the emergency room.
“From the very first moment a patient presents with critical illness, when they are at their sickest moments here in Albuquerque or throughout the state, they are getting streamlined care that is consistent and evidence-based from the emergency department, beginning in minute one and continuing throughout their stay,” says UNM's Isaac Tawil, MD, who developed and is implementing the new program.
The centerpiece of the EDRU is a quarterly educational initiative focused on particular areas of critical care, such as neuro-resuscitation, airway and ventilation, and vascular access mastery.
“It’s a multi-pronged effort that includes everything from bringing in new technologies to protocolling care for the subsets of pathologies where there exists a best practice,” says Tawil, an associate professor and critical care specialist in the Department of Emergency Medicine. “We produce an algorithm of care where I, or any one of my colleagues, can come on at any time of the day or night and know we are approaching certain disease processes in a similar fashion.”
For example, Tawil and his team have efficiently simplified the diagnosis process to recognize and treat strokes. The quicker a stroke is diagnosed, the quicker clot–busting drugs can be administered.
In another initiative, EDRU created an airway checklist, implementing new best practices for using a mechanical ventilator and creating standards to help decrease ventilator-associated pneumonia rates. These practices are as simple as making sure patients’ beds are tilted at the right degree and ensuring proper oral care and suction.
A third initiative focused on perfecting placing various kinds of medical lines in patients.
Pearl Richins, a registered nurse and director of nursing for emergency services, is a huge fan of the venture and believes emergency department patients will continue to see the benefits in the future.
“Overall this has been really good for us,” she says. “And it’s only going to get stronger. As a Level I Trauma Center it will only improve the quality of care we provide.”
Tawil says the importance of team-building and fostering a culture of unity among the physicians, nurses and technicians who participate in the program can’t be overstated.
“We actually have components where the nurses and techs are teaching the physicians to do a procedure that is typically relegated just to them,” he says. “If we want to function as a team and get the best care and best therapy to patients right away, then we have to make use of all staff members’ expertise.”
This knowledge sharing has allowed Richins and her staff to offer their experience and expertise and be respected for it.
“Not that this wasn’t always so, but working on these initiatives together has empowered both sides to have an open dialogue,” she says. “This has opened doors for nurses and physicians to intermix and share their knowledge. Being able to teach each other and have mutual respect for each other is helping the relationships between the staffs.”
UNMH just hired its eighth emergency medicine practitioner who has sub-specialized in critical care, making it one of the largest critical care faculties in the nation, according to Tawil.
“There are a couple of EDRU’s popping up around the country,” he says. “But you certainly won’t see anything like this anywhere else in New Mexico. You won’t even see it at most university-based academic hospitals.”
For more info on the EDRU and a deeper look at each initiative, you can visit the project’s website.