The Massachusetts General Hospital Department of Emergency Medicine was built two decades ago to accommodate 60,000 patients. Today, the Sumner M. Redstone Department of Emergency Medicine handles 90,000 visits annually, and that number is steadily rising. As many patients as they treat within the ED’s (Emergency Department) own walls, its staff members view patients the world over as their own: the ED has specialized units for things as diverse as wilderness medicine, disaster medicine — many staffers flew to Haiti to assist in the January earthquake’s aftermath — and advancing the use of emergency ultrasound in developing countries. The department is a Level I Adult Trauma Center, Level I Pediatric Trauma Center and Level I Burn Center, and it receives many seriously injured patients via Boston MedFlight helicopter, aircraft and ground ambulance.
So it’s busy. And that’s an understatement. Patients are often seen on stretchers lining the halls while waiting for inpatient beds, but the new building will help to address the overcrowding.
The statistics tell the story, and dramatically so: today, about half of all inpatient admissions come through the ED, up from about a third in the 1980s. It treats patients who are sicker and more badly injured than most U.S. hospitals. Nationwide, 13 percent of emergency patients are too ill to go home and are admitted to the hospital for overnight stays. At Mass General, it’s 28 percent.
“We see many of the most challenging cases coming in on a regular basis, and they continue coming in with greater frequency as our reputation for expertise in so many areas of medicine just grows and grows,” says Dr. Alasdair Conn, MD, chief of Emergency Services.
When it relocates and expands into the new Building for the Third Century, the ED will double in space to nearly 38,000 square feet, allowing the addition of new beds and examination rooms. More inpatient rooms will hasten the movement of patients out of the ED and into hospital beds. The new ED will include nine triage rooms, up from the current four, and an enlarged ambulance bay that will accommodate 16 ambulances, up from the current space for 10. The ambulance bay will double as a hazardous materials — or “hazmat” — area specially designed to decontaminate or treat large numbers of patients involved in a potential environmental disaster or terrorist incident.
The expansion will help the ED grapple with the rising tide of patients, but the new space is only part of the solution to effectively handle the burgeoning patient load, says Dr. Conn. Well before the first stone was laid for the new building, efforts were already in place to increase the efficient movement of ED patients to inpatient floors, with great success. In recent years, wait times have dropped to three-and-a-half hours, down from five-and-a-half. The hospital continues to work to improve even further.
“I am always explaining to patients waiting for an inpatient bed, ‘You are booked into the hotel. It’s a busy, popular hotel and your room is still occupied upstairs. We have to wait until that patient checks out and then we can get you checked in,’” says Dr. Conn.
Understanding that quickening the pace of diagnoses will also help improve efficiency, the staff has gradually transformed the ED into a rapid diagnostics center. With more MRI, CT and PET/CT machines than most major hospitals in their EDs — and more to be added with the ED’s expansion to the new building — physicians are diagnosing patients faster, precluding the need for some emergency surgeries and moving patients into inpatient beds or home.