Crouse Health Ushers in a New Era of Emergency Care for Central NY

By Jennifer Webster
Monday, August 28, 2017

The new Crouse Health Pomeroy Emergency Services Department opened its doors on July 18. Here, visitors experience prompt attention at an advanced facility where the patient-centered design mirrors the thoughtful approach to care embraced by the department’s medical team and support staff.

Crouse Health Pomeroy Emergency Services Department Leadership — (back) Medical Director David Mason, MD; (middle row) Clinical Supervisor Erin Zinkievich; Associate Medical Director Richard Steinmann, MD; (front) Seniora Quality Officer Michael Jorolemon, DO; Nurse Manager Charles Eaton; Clinical Supervisor Jennifer Killoran; and Chief Nursing Officer Betty O’Connor

The $38-million project tripled the size of the previous 40-year-old emergency department, a decision that allowed Crouse to incorporate the latest in patient-centric design, as well as accommodate the hospital’s rapidly expanding patient population — emergency services visits have increased more than 50 percent over the past decade.

Floor space has almost tripled, from 7,800 to 21,000 square feet. Hallways are broader and waiting areas more spacious. Thirty private examination rooms have been added. Patients, families and staff alike find it easier to navigate the space, making for more efficient and timely delivery of care.

“The layout allows us to more efficiently care for patients through our emergency department, to stratify them by risk and triage them much faster, and then treat them appropriately, whether they are admitted to the hospital or return home,” says Seth Kronenberg, MD, Chief Medical Officer at Crouse. “We use care stations where nurses, physicians, nurse practitioners, physician assistants and emergency technicians work together in teams within line of sight of the rooms they’re overseeing. Care stations are based on acuity; they enhance communication and help us allocate resources to patients who need them most.”

“The biggest difference is when patients first enter, they’ll be greeted by a charge nurse and go through triage immediately. I think that is really going to increase patient satisfaction, patient treatment and staff satisfaction, because the patient is going to get to the right place the first time.”
— Betty O’Connor, RN, Chief Nursing Officer, Crouse Health

Crouse Health’s Pomeroy Emergency Services Department

Since more than 150 healthcare professionals treat patients in the emergency department, the added space and improved layout make it easier for everyone to work. The new design facilitates the role of care planners and other non-medical support services staff, too.

“With our new color-coded caregiver stations, all members of the care team, including physicians, nurses, social workers and care coordinators, are able to collaborate on each patient’s needs in a conveniently located and spacious area that is designed to foster group discussion,” says Betty O’Connor, RN, Chief Nursing Officer at Crouse. “This helps us put the patient story together quickly and provide the care he or she needs.”

Prevention: A New Focus in Emergency Care

While many members of the community rely on the Pomeroy Emergency Services Department, certain patients are receiving special attention for a specific reason: they could benefit from having a primary care physician.

Crouse Health Patient Engagement Representative Desiree Odom and Patient Access Representative Janelle Harris work primarily in PromptCare and the emergency department to identify patients who are frequent visitors to each facility. Often, individuals who are not insured or underinsured are unable to connect to primary care resources that are critical for ongoing, overall health.

Crouse Health Patient Engagement Representatives Desiree Odom (left) and Janelle Harris

“We try diligently to help patients navigate treatment and preventive care,” Odom says.

“Our job,” Harris adds, “is to help prevent visits to PromptCare or our ER for what should be routine care provided by their own physician.”

Odom and Harris have been members of the Crouse team for several years. Their work supports the New York State Delivery System Reform Incentive Payment (DSRIP) program. DSRIP promotes community collaboration and focus on system reform, specifically a 25 percent reduction in avoidable hospital readmissions over five years.

Advanced Care, Easily Accessible

Patients experiencing stroke or heart attack need advanced treatments and rapid care delivery. At Crouse, resources are in place to make both possible. Door-to-balloon times for heart attack patients average 43 minutes, compared to a state average of 57 minutes. In fact, Crouse is the only area hospital designated as a Mission: Lifeline Gold provider by the American Heart Association for implementing specific quality improvement measures for the treatment of patients suffering severe heart attacks.

Stroke care is similarly outstanding — Crouse is designated as a Stroke Center by the New York State Department of Health and has received the American Heart Association and American Stroke Association’s Gold Plus award every year since 2012. In 2017, Crouse received the Gold Plus Elite designation from the AHA/ASA for superior stroke care.

The new design only enhances the excellent care provided for stroke and heart attack patients, and those benefits begin even before patients enter the hospital. Now, the emergency department can accommodate multiple ambulances at the same time, improving care for patients and providing EMS providers with more rapid turnaround time.

Inside, services are organized strategically to help coordinate the teams of providers focusing on specific conditions. Patients with similar medical conditions are treated in the same area alongside relevant technologies, creating efficiencies of care. For example, stroke patients are assigned to examination rooms near the CT scanner. Similar intelligent layout plans benefit patients who complain of chest pain.

“These changes allow our cardiac patients better triage and better flow through the emergency department,” Dr. Kronenberg says. “They are able to reach the cardiac catheterization lab sooner for lifesaving treatment.”

Members of the Crouse ER team: Krystal Ashby, Michael Mastroleo and Angela Binion

Our Front Door

At Crouse, the emergency department is where most patients first meet physicians and staff. Fifty-four percent of admissions originate in the emergency department, which sees 82,000 patient visits a year. Though one of the busiest emergency services departments in the region, it’s also a welcoming one. This year’s major expansion, made possible by the generous support of long-time Crouse supporters Bill and Sandra Pomeroy, was carefully planned with the patient experience in mind.

“Bill and Sandra Pomeroy are a unique couple who are extremely generous not only with their financial resources but with their time. Their involvement, passion and commitment to our mission have allowed us to undertake major improvement projects, such as expanding emergency services, that are keeping Crouse on the forefront of patient-focused care in Central New York.”
—Kimberly Boynton, Chief Executive Officer, Crouse Health

“The new space allows us to be thoughtful about the experiences of walk-in patients and those who arrive by ambulance,” Dr. Kronenberg says. “We designed it so care is streamlined even before patients enter our doors.”

“When patients walk in the door, they see the charge nurse first,” O’Connor adds. “They are immediately triaged to the level of care they need. They appreciate being seen first by a medical professional — it helps put patients at ease and lets them know that their concerns are being taken seriously.”

Input from patients, visitors and staff was incorporated at every step of the new design. At their recommendation, a quiet room was added for families experiencing distress or loss. In this space, they can pray, make telephone calls and take light refreshments.

“It says a lot that our employees have been willing to change the way they work to improve services for our patients,” O’Connor says. “Change is never easy, but our staff understands the importance of these updates and embraces them.”

Members of the Pomeroy Emergency Services team at Crouse Health. In 2016, there were more than 82,000 patient visits to Crouse’s ER and PromptCare, making it among the busiest in the region.

The Pomeroy Emergency Services Department represents a new era in the hospital’s more than 130 years of service to the community. With Phase 1 complete, the stage is set for new developments as the next phase unfolds in 2018. In Phase 2, PromptCare, Crouse’s urgent care service, will move into an adjacent space.

“The emergency department and urgent care will become one contiguous unit,” Dr. Kronenberg says. “We will create a rapid evaluation unit, where we separate high- and low-risk patients. Those with low risk won’t have to go through the emergency department but will receive care in a quiet, efficient setting where they can be treated and discharged sooner.”

“We continue to see growth in emergency services, not just at Crouse Health but throughout Syracuse and nationally. Our goal is to provide the right care in the right setting. If someone needs to be admitted quickly, we take them to the emergency department and get them to the appropriate floor in the hospital, and when admission is not necessary, we have a social worker, care coordinator, provider and nurse who work as a unit, making sure patients are referred to the appropriate level of care.”
— Seth Kronenberg, MD, Chief Medical Officer, Crouse Health

Sparing patients the debate about whether to visit the emergency department or wait for a medical appointment, the PromptCare unit will provide fully integrated care, whether patients need a brace for an injury or an evaluation of their chest pain. Physicians in the community will have a single point of referral for urgent and emergent care to a location where experienced nurses and board-certified emergency care physicians can examine and triage each patient appropriately.

“Crouse is a community hospital that is locally governed, so when we saw the opportunity to follow our mission of providing the best patient care and promoting community health, we took it, and the community has rallied behind us,” Dr. Kronenberg says. “Now, when patients arrive at the emergency department, they’ll be triaged immediately; they’ll receive excellent care in the region’s most up-to-date, advanced emergency services facility, delivered by professionals who put the patient experience first.”

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