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Salem Health invests $3 million in ED expansion 

By Joshua Walterscheid, MD, ED medical director

Salem Health is investing $3 million to expand the Salem Hospital emergency department to meet the needs of the growing community. Completion is set for next February. In the eight year life of the

Walterscheid, Joshua K.

 hospital’s Building A, this will be the third expansion to the ED. Demolition started in September.

Salem Hospital’s emergency department is already the busiest ED on the West Coast between Canada and San Diego, seeing over 300 patients per day on average.

The plan includes adding eight treatment rooms, two consult rooms, a phlebotomy draw station, 24 results-pending chairs and a new treatment track for patients with 

ED floor plan small

less complicated diagnoses. This is also a redesign of the flow of patients, with the goal to decrease the time it takes for patients to see a provider.

Patient flow changes

Before the patient flow changes, a triage nurse examined a patient, assigned them an ESI number and sent them to a room for treatment.Here’s how the new flow will work:

  1. A triage greeter nurse will greet and briefly assess the patient (30-second evaluation, no physical exam) and direct the patient to the rapid assessment unit (Emergency Service Index, 4, 5 patients), the core (ESI 1, 2 patients) or the fast track area (ESI 4, 5 patients; when open).
  2. If directed to the rapid assessment unit, a nurse and provider, often simultaneously, will see the patient upon entering and initiate a work-up.
  3. The room must be rapidly turned over for the next patient, so the patient will move to the phlebotomy draw station or the results pending area, a waiting area where patients are closely monitored by nursing, to await orders being carried out, tests carried out or test results. Patients also can receive IV fluids and doses of IV medication while in the RP area.
  4. Once all test results are back, the patient will be moved to the consultation room for final assessment and disposition from the provider.
  5. Some patients will not require a final assessment (ESI 4, 5 patients) and may simply be discharged from RP once they are given medication that was ordered, splint placed, etc.
  6. Some patients may be seen in the RAU and be determined to be more ill than first thought by triage greeter nurse. They may be sent to the core after their initial evaluation in RAU and have their evaluation/treatment completed by a different ED provider working in the core.

To emphasize, there will be a fast track area for patients with less complicated medical problems in the existing provider at triage area, which will be repurposed with five to seven rooms. The fast track will be open in the afternoons and evenings; low acuity patients will go here when it’s open. We are planning for the new RAU patient flow model to be open from 6 to 2 a.m. daily. The fast track area will likely be open for 8 to 12 hours daily.

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