Meet Michigan Medicine: Adult Emergency Services
Growing patient volumes and increasing patient complexity have been common trends across U-M Health in recent years and, even more so, during the pandemic.
As the first point of contact for many patients at Michigan Medicine and the gateway to the health system, Adult Emergency Services — or AES — is at the forefront of balancing care for COVID-19 and non-COVID-19 patients and providing timely, high-quality care to an extremely diverse and often severely ill or injured patient population.
Approximately 450 faculty, staff and learners work within AES, performing a variety of crucial functions. Among them are valet and guest services, registration, unit clerks, attending physicians, physician assistants, residents, fellows, medical students, nurses, respiratory therapists, physical therapists, emergency services technicians, security and environmental services personnel, pharmacists, care managers, social workers, administration, and operational support staff.
Everyone works together to ensure that patients are well cared for from the moment they arrive until they are discharged, admitted to an inpatient unit or sent home to receive hospital-level care through the Care at Home program.
“We’re all very committed to building and maintaining a highly coordinated team that’s ready to provide exceptional care for anyone who comes through our doors,” said Nick Valentini, M.D., a house officer in AES.
“Our greatest challenge is responding to new demands on the health system,” he said, “whether that be reduced inpatient capacity, caring for more patients that place higher demands on staff, or taking on more of a primary care or care coordination role for those vulnerable patients in our society who otherwise cannot, or choose not to, access care by other means.
“We will always be here to fill the gaps,” said Valentini.
A typical day
Ask a variety of different team members in AES to describe a typical day at work and, most likely, they all will give you the same answer: there is no such thing.
“Sometimes I wish there was a typical day in the emergency department,” said Megan Bolen, PA-C. “No shift that I’ve worked in my almost 15 years has ever been the same, but that’s what makes emergency medicine exciting.”
On average, the AES team cares for 200 patients each day, with ailments from minor injuries to life-threatening illnesses. In the last several weeks, approximately 40% of patients in the emergency department have sought care for COVID-19-related symptoms. Recently, those numbers have started to decline.
“As with all emergency rooms across the country, activity varies by time of day and day of week, with our highest census between the hours of noon and midnight on weekdays,” said Jennifer G. Holmes, R.N., B.S.N., MHSA, director of operations for Adult & Children’s Emergency Services.
“During peak COVID-19 activity, we had as many as 80 patients waiting to be seen across multiple waiting areas,” added Jon Fairchild, M.S., R.N., C.E.N., AES clinical nursing director.
Managing patient volumes
“We do the best we can to see each patient in a timely manner,” said Kristina Masters, PA-C. “Some days that can be really tough.
“Things can get really hectic down here,” she added. “We’re usually juggling several things all at once while trying to remain cool, calm and collected.”
Elizabeth Herczak, emergency services technician, agreed.
“We have to adapt very quickly,” said Herczak, “so we’re always thinking fast. It’s great that we can all work together to accomplish what needs to be done.”
During high volume times, AES team members do everything they can to care for patients quickly — even when that means caring for them in unconventional locations.
“We have physician assistants and attendings who will come out and see patients in the waiting room,” said Brittany Downing, R.N., registered nurse. “We all see patients wherever we can see them, just to help with the workload.”
AES leaders are currently working in partnership with leaders in University Hospital and the Frankel Cardiovascular Center on efforts to accommodate and treat patients in a timely manner.
“We have initiated three multidisciplinary, cross-departmental teams focused on input, output and throughput within AES visits,” said Dave Somand, M.D., FACEP, medical director for AES. “Each team will address opportunities to improve efficiency, reduce overall length of stay and ensure optimal patient and staff experience.”
Providing innovative care
“Innovation is a key value that’s been driving a lot of our work in the emergency department,” said Nicole Klekowski, M.D., clinical assistant professor in the Department of Emergency Medicine who works in both Children’s Emergency Services (CES) and AES.
“Some of the innovation has been around clinical care for patients with COVID-19, such as exactly what therapies are indicated and how we’re delivering those to our patients,” she said.
Other innovations include finding spaces to best care for patients in the face of inpatient capacity constraints, and leading research and advancements to continually improve the practice of emergency medicine.
In 2015, AES opened the Emergency Critical Care Center, or EC3, the first ICU in the country to be housed within an emergency department. A life-saving innovation, EC3 enables the AES team to provide rapid diagnosis and rapid access to ICU-level care for the most critically ill and severely injured patients.
Building meaningful connections
In addition to the belief that there’s no typical day in AES, the other thing faculty, staff and learners agree on is that teamwork across all areas of the department creates a sense of togetherness and makes what can often be incredibly challenging work more bearable.
“We see some really horrible things here,” said Downing. “The fact that we are able to work together and get through those things, I just truly think that the teamwork and talents and strengths that come through with my coworkers is amazing.”
“You hear about people developing strong bonds after going through stressful life events together,” said Masters. “Working in the emergency department, those stressful events are an inevitable part of every day. As a result, it doesn’t take long to build lasting connections with your colleagues.”
In addition to the natural relationships and support that develop between team members, AES works with the Office of Counseling and Workplace Resilience to bring people together for debriefs after difficult events. The department has established a Wellness Committee and is in the process of rolling out a peer-to-peer support program.
“It’s an incredible setting to work as a team,” said Herczak. “The team has become more of a family for me, and I know it has for many others, too. That’s just something you don’t find everywhere.”