Emergency Medicine

Get With The Guidelines: Coronary Artery Disease, Heart Failure, Stroke Care

Triple Gold Performance Achievement
American Heart Association, 2008 and 2009

"100 Top Hospitals®: Cardiovascular Benchmark for Success"

Thomson Reuters, 2008 & 2009

Chest Pain Alert Team – Best Hospital Program

South Florida Business Journal Excellence in Healthcare Award

The Emergency Department provides patients rapid access to over 35 Cleveland Clinic specialties:

Electronic Medical Records

Cleveland Clinic is at the forefront of electronic medical records.  Part of this effort includes a nearly paperless work environment, featuring electronically-generated discharge instructions and fast-track assessment protocols to eliminate the inefficiencies that hamper many other emergency rooms across the nation.

Our Emergency Department is one of only two in Broward County which offers intravascular cooling for patients with cardiac arrest with return of spontaneous circulation.  Many studies have shown improvement of patient outcomes and decrease in neurologic disability in patients who receive cooling post cardiac arrest.

Intravascular Temperature Management (IVTM™)

Alsius proprietary IVTM™ technology gets to the core of the temperature issue by managing patient temperature from the inside out.

The benefits of IVTM™ include:

• Superior temperature control 
• Improved patient access 
• Reduced nursing time 
• Triple lumen central venous catheter access

Clinical

Temperature is Vital

Today, major medical societies recommend temperature management as the standard of care therapy for many critically ill or surgical patients.

Therapeutic Cooling

• Reducing Fever
• Induced Hypothermia following cardiac arrest, spinal and brain injury 
• Other

Therapeutic Warming

• Trauma and accidental hypothermia
• Surgery
• Other

Society Recommendations

Many internationally respected medical societies recommend temperature management as the standard-of-care for many critically ill or surgical patients.

• ASA - American Stroke Association
• AANS/CNS- American Association of Neurological Surgeons
• EUS - European Stroke Initiative
• AHA - American Heart Association
• ILCOR - International Liaison Committee of Resuscitation
• ASA - American Society of Anesthesiologists
• ASPAN - American Society of PeriAnesthesia Nurses
• ACS - American College of Surgeons
• AHA/ASA - Guideline from AHA/ASA Stroke Council

Therapeutic Cooling

Reducing Fever

Incidence of Fever in Neurointensive Care Unit

Clinical studies have shown that elevated body temperature in neurologic intensive care patients is associated with a longer ICU and hospital length of stay (LOS), higher mortality rate and worse outcomes.

*Alsius IVTM™ System was shown to be 64% more effective than surface cooling techniques for fever reduction in neurologic intensive care unit patients.

Induced Hypothermia

Induced Hypothermia

Many hospitals are adopting the American Heart Association guidelines for treatment of cardiac arrest. Clinical studies have shown that induced hypothermia in patients resuscitated after cardiac arrest helps to prevent neurologic damage and improve outcomes.4 These caregivers understand the temperature management challenges of implementing this protocol including:

• lower the temperature (32°-34°C)
• maintain target temperature for 12-24 hours \
• controlled re-warm back to normal temperatures (37°C) 
• prevent rebound fever

*Patients cooled with the Alsius IVTM™ System had 2-fold increased odds of survival and had significantly reduced mortality and improved favorable neurological recovery at 30 days compared with the control group.

Emergency department visits in the US hit a new high in 2005, with more than 115 million visits, says new research from the CDC. That's a jump of five million visits over the previous year, and a substantial 20 percent increase over 10 years.

Over the same time period, the number of hospital EDs decreased more than 9 percent from 4,176 to 3,795, the CDC says. More than half of these patients (62.8 percent) were referred to a physician or clinic for follow-up after their visit, suggesting their needs were not critical. The study provides more fuel for the campaign underway by the American College of Emergency Physicians (ACEP), asking Congress to approve a law creating a commission to study the ED overcrowding problem. Under the terms of the ACEP-backed bill, hospitals would have to report to HHS on how many patients are boarded in the ED, and how long they are boarded.

Every day in the United States many Emergency Departments are faced with overcrowding, busy waiting rooms, and admitted patients occupying beds when the inpatient beds are not available. To combat this problem we have instituted advanced nursing orders. These physician orders are started upon patient’s arrival to Triage. This allows us to shorten the length of stay in the Emergency Department significantly, allowing admitted patients to go upstairs sooner and non-admitted patients discharged quicker. Efficiency is the goal.

Cleveland Clinic Florida Emergency Department Average Length of Stay (2009)

• Patients not admitted to the hospital = 89 minutes
• Patients admitted to the hospital = 110 minutes

Average time to be seen by a Cleveland Clinic Florida Emergency Medicine physician (2009)

• 22 minutes

Pneumonia - Community-acquired pneumonia (CAP) is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs (pneumonia). CAP is a common illness and can affect people of all ages. CAP often causes problems like breathing, fever, chest pains, and a cough. CAP occurs because the areas of the lung which absorb oxygen (alveoli) from the atmosphere become filled with fluid and cannot work effectively.

CAP occurs throughout the world and is a leading cause of illness and death. Causes of CAP include bacteria, viruses, fungi, and parasites. CAP can be diagnosed by symptoms and physical examination alone, though x-rays, examination of the sputum, and other tests are often used. Individuals with CAP sometimes require treatment in a hospital. CAP is primarily treated with antibiotic medication. Some forms of CAP can be prevented by vaccination.

Evidence-based "core measures" for management of Pneumonia have been promoted by the Centers for Medicare and Medicaid Services (CMS) and Joint Committee for Accreditation of Healthcare Organizations (JCAHO), which form the basis for the public reporting of hospital performance in CAP care. Here at Cleveland Clinic Florida, we are proud to say that 100% of patients who are diagnosed with pneumonia receive antibiotics in the Emergency Department within 4 hours of arrival.

Almost 500,000 Americans each year have an ST-elevation myocardial infarction (STEMI), but these events can be quickly recognized and treated to reduce further heart damage. In 2004, the American College of Cardiology (ACC) and American Heart Association (AHA) released joint guidelines for treating STEMI. Since then, new clinical trial data on a variety of aspects of STEMI care have emerged, prompting ACC/AHA to update portions of the 2004 joint guidelines in late 2007. In addition to other data, late-breaking clinical trials presented at the 2005 and 2006 annual scientific meetings of the ACC, AHA, and European Society of Cardiology were reviewed to identify key information that has since impacted the guideline recommendations.

Published in the January 15, 2008 issues of Circulation and the Journal of the American College of Cardiology (www.cardiosource.com/guidelines), the new ACC/AHA guidelines reinforce the goal of restoring blood flow to the heart as quickly as possible during the initial treatment of STEMI. “We have evidence showing that improved systems of care can lead to faster times to reperfusion, resulting in better outcomes for patients with STEMI,” says Elliott M. Antman, MD, FACC, FAHA, who chaired the guideline writing group.

Cleveland Clinic Florida’s Emergency Department along with the Interventional Cardiology program boasts the best average time from the time a patient arrives to the ED to the time reperfusion is established in the cardiac catheterization lab (average 55 minutes).

Our ED uses the LIFENET STEMI Management Solution. This allows our ED to receive EKGs from the field transmitted by Paramedics. The EKG is simultaneously transmitted to our Interventional Cardiologist on call. This allows our team of physicians to quickly confirm STEMI diagnosis, activating the Cardiac Catheterization Lab making the lifesaving treatment readily available.

At Cleveland Clinic Florida, we are proud to provide quality healthcare to patients of all ages. This includes every member of your family as our physicians are trained and board certified in all aspects of Emergency Medicine.

11 % of all Emergency Department visits here at Cleveland Clinic Florida is of the pediatric age group. Our close relationship with two of the best local tertiary pediatric hospitals, Miami Children’s Hospital and Joe Dimaggio’s Children Hospital, allows for comprehensive continued care.