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844 Doctors in 31 Specialties CONNECTICUTOral History: CPTV AT 50 | Homeowners Fleeing the ENERGY GRID | FRENCH FETES connecticutmag.com MAGAZINE Did your doctor makeTop the list? Docs 844 DOCTORS IN 31 SPECIALTIES PLUS The Friendly New Face of Emergency Departments Customer care and controlled chaos in the old ER APRIL 2013 $4.95 Yale-New Haven Hospital Adult Emergency Room residents confer while using a COW—Computer On Wheels, a completely portable, self-suffi cient computer-information system that al- lows doctors, nurses, residents and other care providers to send, receive, edit and access patient information. It can also be used to inform patients directly. '(),1,1* (0(5*(1&<%<(5,.2)*$1*3+272*5$3+<%<-()).$8)0$1 :,7++($/7+&$5(5()2506,1685$1&(&+$//(1*(6$1'7+( ,1&5($6,1*'(6,5()2521(67230(',&$/$66,67$1&(7+( (0(5*(1&<5220+$6(92/9('%(<21'7+(6,03/(´(5µ Back in the 1790s, during the French Revolution, military surgeon Dominique Jean Larrey had an epiph- any. He noticed how rapidly the fl ying artillery (horse-drawn cannons) of the French army transported weapons across the battlefi eld and realized they could be used to save lives instead of destroy them. He created fl ying ambulances, horse-drawn stretchers that quickly transported wounded soldiers away from the front lines to places where they could be treated more eff ectively. It was a giant leap in medical history and saved thousands of lives. As a result, Larrey oft en is acknowledged as the father of emergency medi- cine. More than 200 years later, emergency medicine continues to use cutting-edge technology to save lives. Some Connecticut hospitals are mak- ing emergency department wait times available on their websites, others regularly use video conferencing to have patients examined by experts from other parts of the globe, and emergency departments routinely employ new treatments to save the lives of patients in ways that would not have been possible in the past. Even the name has changed. “I know the TV show was called ‘ER,’ but in the hospital setting you’ll always hear the ‘emergency department.’ We’re no longer a big room where everyone goes,” says Dr. Peter Jacoby, chairman of emergency services at Saint Mary’s Hospital in Waterbury. Th e way emergency departments are being used by the general public also has changed. A report released in October by the Association of American Medical Colleges estimates the nation is short approximately 9,000 primary-care doctors. As the availability of general practitioners declines, emergency departments oft en have fi lled the health care void out of necessity. | APRIL 2013 CONNECTICUT 69 | (above) Hospital of Central Connecticut Dr. John Sottile and nurses evaluate an EKG transmitted remotely from EMTs in the fi eld. (opposite top) Hospital of Central Connecticut Dr Sottile uses an iPad and other technolo- gies to help put a young patient (and mom) at ease. (opposite bottom) Yale-New Haven Hospital Dr. Gail D’Onofrio, Chief, Yale-New Haven Hospital Department of Adult Emergency Medicine, confers with a colleague regarding patient information (EKG, radiology, heartbeat, etc.) accessible on her smartphone. | 70 APRIL 2013 connecticutmag.com | “We’ve become the answers to everyone’s problems,” Jacoby says. “We are expected to do much more besides the very acute emergencies.” Dr. Gail D’Onofrio, chief of the emergency department at Yale-New Haven Hospital, agrees that “emergency” visits will be increasing. “I think with the Aff ordable Care Act we may see even more people because more will be covered by some type of insurance,” she says. “What we’re hoping for down the road is that we have more primary-care doctors to keep the popula- tion healthy and to work on prevention.” Th ough emergency departments may be busy, both Jacoby and D’Onofrio say the vast ma- jority of patients who come in do need treatment and the services provide a level of conve- nience for them. “You can say, well, is an injured ankle an emergency?” Jacoby explains. “If you decide to wait and call your primary-care doctor, and then go get an X-ray, and then you have to go fi nd crutches and fi gure out how to get off that ankle, and then get an appointment with an orthopedic physician, that might take you a week. If you come to the emergency department you may wait a little while, but we’re going to X-ray you, we’re going to set you up with your crutches, we’re going to fi x your leg and we’re going to get you a referral to an orthopedic physician.” He adds, “In the United States we are used to one-stop shopping. We don’t like to go to 50 stores anymore; we go to malls to shop. We go to emergency departments because we know we can get seen, get diagnosed and get treatment 24/7.” ”IN THE UNITED STATES WE ARE USED TO However, frequent use of emergency de- partments can lead to overcrowding, espe- ONE-STOP SHOPPING,” SAYS DR. PETER cially when there’s an outbreak of an illness, JACOBY, CHAIRMAN OF EMERGENCY SER- as was the case in late December and early VICES AT SAINT MARY’S HOSPITAL IN WA- January when the state saw a spike in infl u- enza cases. TERBURY. “WE DON’T LIKE TO GO TO 50 “Emergency departments everywhere were STORES ANYMORE; WE GO TO MALLS TO fl ooded,” Jacoby says. “We saw a lot of fl u cases and there was a very virulent respiratory viral SHOP. WE GO TO EMERGENCY DEPART- disease, and a GI viral disease going around MENTS BECAUSE WE KNOW WE CAN GET as well. It’s like the perfect storm—you have all that coming in and you have all the car ac- SEEN, GET DIAGNOSED AND GET TREAT- cidents, strokes and heart attacks that you get MENT 24/7.” all the time as well.” Although things may have gotten hectic at Saint Mary’s, Jacoby says that doesn’t mean the emergency department was strained to a breaking point or that patients shouldn’t be en- couraged to come in for treatment. “You still manage to see them all and you just have to examine those who you think are the sickest fi rst,” he says. Ralph Miro, director of nursing and EMS coordinator for the Department of Emer- gency Medicine at Day Kimball Healthcare, which operates Day Kimball Hospital in Putnam, agrees patients should never be discouraged from coming to the emergency department. “Until you’re assessed by health- care professionals, there’s no way to tell if something that may seem minor could be very major,” he says. “Let’s say you have left arm pain or right arm pain or jaw pain—that could be a sign of a heart attack.” | APRIL 2013 CONNECTICUT 71 | He adds, “Patients who feel that their complaints or their symptoms are serious— what they should not do is ignore them.” Patients also needn’t worry that their bro- ken ankle will take away needed resources from sicker people, says Miro. Emergency- staff members are trained in triage, or assess- ing the most critically ill patients to make sure they get priority treatment. Th is ability to quickly assess need is an area where emer- gency medicine has advanced signifi cantly, aided by now common lifesaving practices such as “point-of-care” testing. “It’s a procedure that enables us to de- termine a patient’s condition, or to identify certain disease states, by evaluating the con- tent of a patient’s blood,” Miro says. Blood now can be analyzed at a patient’s bedside thanks to devices like the i-STAT System, a handheld blood analyzer that can provide lab-quality test results on the spot. “Instead of drawing multiple tubes of blood, all we need is a few drops in an i- STAT,” he says. “Th ose drops of blood, as lit- tle as two, are placed into the unit and rather than having to wait for the results from our lab, the results come within a few minutes.” Major advances like this aid in better treating heart attacks and strokes, where time is critical. Using point-of-care treat- ments like i-STAT, which can test for cardiac markers, staff can assess more quickly what type of heart attack a patient is having and then send him or her to a catheterization lab where they can be treated properly. Th ere are also new medications that slow down the damage caused by a heart attack or a stroke, and innovative techniques such as therapeu- tic hypothermia, a method by which medi- cal staff can lower the patient’s body tem- perature to slow down brain damage. Not all the new technology being used is specifi c to the health-care industry. Advanc- es in videoconferencing technology have allowed patients at Day Kimball to be ex- amined remotely by specialists at the UMass Memorial Medical Center. “We can zoom in on the patient and a neurologist all the way over at UMass can assess the pupils and skin color,” Miro says. In addition to technological advances, another trend in emergency medicine today is in customer service. Dr. Jeff rey A. Finkel- stein, chief of emergency medicine and chief medical information offi cer at the Hospital of Central Connecticut, says the hospital | 72 APRIL 2013 connecticutmag.com | treats visitors like “customers as opposed to patients.” Th e hospital, which has campuses in Southington and New Britain, features valet parking at the entrance to the emergency de- partment and people are off ered coff ee and warm blankets as soon as they come in.
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