Emergency Care Center
The ECC is the busiest pediatric emergency department on the West Coast. From July 2012 through June 2013 (FY2013), 74,999 patients arrived in the ECC for treatment. This represents more than a 5% increase in volume over the previous year. In spite of this massive increase in volume, the Division continues to make strides in improving customer service and increasing access.
The ECC is the most common entrance for admitted patients at RCHSD. Ten percent of the patients that are seen in the ECC are admitted. This accounts for over 50% of the total admissions to RCHSD. It is the receiving unit for emergency transports brought in by paramedics and Mercy Air. The Division provides continuous feedback and consultation regarding pediatric pre-hospital and disaster preparation and care in San Diego.
Quality Improvement Initiative
The ECC continues to strive to improve the quality of care and to increase satisfaction with the services. A continuing challenge in emergency departments around the country is how to reduce the interval from arriv al to evaluation by a clinician. To succeed, groups have had to wrestle over finding the right levels and kinds of staffing, space and operations. This site is no different. Over the years, meetings are held regularly with various stakeholders to examine reasons for delays to care and to fashion solutions. Ongoing deliberations have yielded useful insights and suggested possible solutions. One finding was the negative impact on left without being seen rates (LWBSR) of the number of patients present in the ER for over 400 minutes. By reducing the number of patients with prolonged ECC stays, there was a salutary effect on LWBSR. In turn, lower LWBS rates resulted in improvements in patient satisfaction. These findings were published in the Society for Health Systems (SHS) monthly newsletter. Other operational innovations have yielded similar results. Examples include a winter influenza clinic noted to improve lengths of stay and LWBSR during the last influenza epidemic; nurse initiated orders; changes in clinician workflows to maximize efficiency; data-optimized matching of patient arrival times to shift times; direct bedding of patients; and bed-side registration.
The ECC has also recently increased the number of beds and presently reconfiguring the ECC floor plan to increase overall efficiency. An aggressive program of physician and mid-level provider recruitment has begun to better match service demands to supply. Efforts to optimize electronic medical records are ongoing and have yielded improvements in safety and quality of medical care, created opportunities for research, and afforded the ability to perform the kinds of audits that are helpful for identifying areas in need of attention and quality improvement. There are now several clinical pathways that have been developed for use in ensuring high quality care for all guests. Most importantly, beyond efforts centered in the ECC, a number of complementary programs are being pursued at the hospital to improve the efficiency of patient flow through the hospital. ECC-based and hospital-wide innovations are expected to further improve safety, quality and efficiency as measured by wait times, lengths of stay, safety events and patient satisfaction.
URGENT CARE CENTERS (UCC)
Under the leadership of Dr. Katherine Konzen, Urgent Care Medical Director, the Urgent Care Centers saw 47, 909 patients at the four off-site urgent care facilities last year. This was over a 20% increase from the previous year. The Urgent Care Centers provide nearby access to local communities so that parents and patients do not need to travel to the RCHSD Emergency Care Center. The Urgent Care Centers provide quick access to a board certified pediatrician and pediatric trained nurses when the family’s doctor or pediatrician’s office is closed in the evenings and weekends. C linics provide after-hours care 365 days a year. The sites are open 4pm-10pm weekdays and holidays, and 1pm-10pm on weekends.
The North County Urgent Care is located at 625 W. Citracado Parkway, Suite 100, in the North County Medical Office Building. RCHSD leases space to run CCS specialty clinics during the day and the Urgent Care Center in the evenings and weekends. This site is located off Interstate 15 on the corner of Felicita and Citracado Parkway. This past year, our team of providers saw 11,922 patients.
The East County Urgent Care facility was re-opened in March 2008 on the Grossmont Medical Center Campus. This Urgent Care facility is conveniently located for people who live in East County communities such as La Mesa or El Cajon. This site has grown significantly since its re-opening, and saw 12,029 patients this year.
The Mid-City Clinic was designed to provide comprehensive services for a largely underserved population in City Heights based on a creative model. The Mid-City Clinic sees primary care patients at the site during the day. The Urgent Care team sees patients in the evening, and provides service that is unparalleled in quality and efficiency to an area where most patients must use public transportation to travel beyond their neighborhoods. This site provides services seven days a week and is open until 10pm. There were 16,524 patients seen at this site this year.
This site is located in Oceanside and is a collaborative effort between Sanford Clinics, CPCMG, CSSD Specialty Clinics and RCHSD. The Urgent Care shares space with the Specialty Clinics. This site opened in April of 2010 and saw 7,398 patients through the end of the fiscal year. This was almost a 50% increase in volume from the previous year.
Teaching in the Urgent Care Centers
There are 2-week long elective rotations for UCSD Pediatric Residents in the Urgent Care. Family practice residents from Scripps also do a 2-week rotation with us. Education is key to our program. Drs. Sarah Judd and Shaun Berger have taken the lead as the coordinators of our educational program. Effective July, 2013 all UCSD Pediatric residents will have a mandatory 2-week urgent care rotation in the Intermediate Care of the Emergency Care Center or in the Urgent Care Centers.
Drs. Adam Braddock and Shaun Berger have both participated in the Introduction to Clinical Medicine program at UCSD.
Drs. Berger, Langley and Konzen have also participated as mentors to the UCSD and SDSU NP Teaching programs.
Drs. Braddock and Konzen have given many lectures to the UCSD medical students and residents on a variety of topics.
Clinical Activities in the Urgent Care Centers
The Urgent Care Center Teams of Physicians, Nurses and Patient Access Reps have had an annual retreat over the past 3 years and work as a team to solve challenging issues. This year, the RN-MD Interaction Survey resulted in a score of 79.19 which is the highest of any division at RCHSD. Monthly team meetings occur to discuss efficiency and patient satisfaction; the focus is on systems issues that can improve our care. The high commitment to efficiency and quality accounts for the large number of patients seen and treated. 2-4% of patients are transferred to the Emergency Department/or Inpatient Unit. Overall, 96% of the patients and families who seek our care are seen.
The provider staff is comprised of 18 board certified pediatric emergency medicine specialists, 6 board-certified pediatricians, and 2 nurse practitioners. All pediatric emergency medicine specialists in the Division have completed residencies in Pediatrics or Emergency Medicine and 2 to 3 years of fellowship training in Pediatric Emergency Medicine. Pediatricians and nurse practitioners staff less acutely ill guests in the Intermediate Care area of the Emergency Center.
The Emergency Care Center is the only emergency care center in the San Diego region solely dedicated to the emergent care of children and the only Level 1 pediatric trauma center in San Diego County. It specializes in the evaluation, diagnosis and treatment of a variety of medical illnesses and injuries. Work continues to improve services to its guests and families.
Heather Conrad, MD, was appointed as disaster director for the Division. She has attended training and has worked this year to help make our ED ready to be the first line-receiving unit for pediatric disaster victims.
Emergency Medical Services
The Division provides advice and direction to the County and City of San Diego in pre-hospital care. We strive to ensure that paramedics are properly supplied with the necessary equipment, education, and protocols to assess and stabilize sick and injured children before they are brought to the hospital. Dr. Jim Harley is on the California State Technical Advisory Committee for EMS-C (Emergency Medical Services for Children).