In 2004, the Emergency Department (ED) at Cleveland Clinic celebrated its 10th anniversary with a major redesign and expansion that quadrupled the size of the department and increased the levels of care.
The expansion, which kept pace with Cleveland Clinic’s tremendous growth over the past years, now enables nurses to deliver care across the continuum of the life span. Care is provided on multiple levels including acute care, fast track or intermediate care, and the clinical decision-making unit (CDU), a 23-hour observation unit. Nurses work in a fast-paced environment that fosters assessment, organizational skills and quick decision making and relies on teamwork and collaboration.
Making a First Impression
Nurses in the Emergency Department have the opportunity to affect patients’ first impressions of the Clinic because a significant number of hospital admissions and transfers come first through the ED.
In the ED’s Clinical Decision-making Unit, nurses educate patients who are not quite ready to go home and are being observed in the 23-hour observational unit. Nurses in the ED are intent on elevating their nursing practice by affecting patient outcomes and the perceptions of care. Initiatives are under way to improve patient flow or throughput, and thereby decrease the patient length of stay in the ED.
In addition, triage nurses, in collaboration with emergency medicine medical staff in the ED have developed protocols to order patients’ lab work and x-rays before a physician sees the patient, thereby expediting care and intervention, and positively impacting patient satisfaction. Physician support of these autonomous protocols by nurses testify to the collaborative professional relationships that help provide exceptional care for patients and build an evidence-based nursing practice.
Richness of Practice
It used to be that emergency departments were islands unto themselves. No more. Now nurses in the ED serve at a vital entry point to the large Cleveland Clinic Health System campus and they play an equally vital role interacting with pre-hospital providers including city and suburban fire departments, the Cleveland EMS units, and the aero-medical transport.
On behalf of patients, nurses in the ED collaborate with every hospital service to ensure patients receive the care they need, including the departments of pediatrics, psychiatry, internal medicine, and surgery, to name a few, as they treat patients at every point along the life span.
Because Cleveland Clinic has the nation’s number one Heart Center, the Clinic’s ED sees a large number of patients with congestive heart failure, chest pain, and acute myocardial infarction. These diagnoses are only one example of many stressful situations that occur in the ED, but they are managed by a strong collaborative effort to provide exceptional care.
Identifying Challenges, Achieving Satisfaction
Continuing advances in technology and treatment options are sure to provide ongoing opportunities for professional growth and personal satisfaction for nurses in emergency services. As the volume of patients in the ED has increased, so has the acuity of their illness.
Due to the nationwide nursing shortage, Cleveland Clinic puts a great emphasis on recruiting and retaining a high quality professional nursing staff. Cleveland Clinic offers an on-site emergency medicine residency program and flexible work schedules. Nurses can work weekends only or work 12-hours, three days a week. All registered nurses are certified in Advanced Cardiac Life Support (ACLS).
As technology continues to affect nursing practice, nurses will be challenged with integrating the Electronic Medical Record (EMR), with the ED triage among the first areas to use the EMR. Strong collaborative relationships within the department on behalf of patients provide the personal and professional satisfaction that helps nurses stay for years in the Clinic’s Emergency Department.
Facts and Figures
As the sixth largest Emergency Department in northeast Ohio, the Cleveland Clinic Emergency Department serves more than 60,000 patients annually.
Recently, the departments of emergency medicine and cardiac services were separated and a clinical director appointed to each department in recognition of its vital role in the Cleveland Clinic Health System. With the expansion of emergency services, the increasing volume and acuity, professional staff are increasingly needed to achieve the patient-centered focus on which Cleveland Clinic bases its care.
In 2003, there were 50,299 total patient visits to the ED with 8,972 admits, an 18 percent admit rate. In the first quarter of 2004, 20,900 patients were seen in the ED with 4,033 admissions, or a 19 percent admit rate. Emergency Services comprise the emergency department with acute care, intermediate care (or fast track), and the CDU, which has 11 beds dedicated to 23-hour observation.
Kaiser Permanente has contracted with Cleveland Clinic for space for their own emergency department, which is staffed by Cleveland Clinic nurses who work side by side with Kaiser physicians in a separate emergency department on Cleveland Clinic's main campus.
Clinical Nursing Director:
Barbara Morgan, MSN, RN
ED CDU: Carmel Matteo, RN
Four Assistant Nurse Managers in ED
Two Assistant Nurse Managers in Clinical Decision-making Unit (CDU)
Kaiser ED: Nemy Vargas, RN
One Assistant Nurse Manager
Staffing/ Skill Mix:
There are 37.6 RNs in the ED and 23.4 RNs in the CDU. RNs are 65% of staff, which also includes paramedics, clinical technicians, patient care service associates and unit secretaries.