Mary Immaculate Hospital – Bon Secours

About the Hospital

• Part of Bon Secours
• 110 Bed, Community Hospital
• 36,000 Annual Visit ED
• 20 Bed ED (main side and fast track)
• 16 private, monitored, Main Side rooms
• 4 private Fast Track rooms
• APPs work both on the Main Side and Fast Track
• 100% Scribe coverage for both EMPs and APPs
• 17% of ED population is PEDs
• 12% admission rate (combined true hospital admits and observation admits)
• Hospitalists admit 85% of the admitted patients in the hospital.
• EPIC EMR System

• Working toward Designated a Primary Stroke Center status

• RN to Patient Ratio: 4 RNs to 8 beds (peak); 3 RNs to 8 beds (low)
• Splinting done by EMPs and RNs
• EMS from Newport News City, Hampton City, York County, EMS from local military base
• Suburban Community

Hospital Resources

• 1 CT machine (64 slice) in the hospital – ED has priority
• Plain Film Suite in the ED
• Radiology in-house from 7A-5P
• Working toward Designated a Primary Stroke Center status
• STEMI Center

• Teleradiology at night
• At night Plain Films read by ED attending
• PAs do discrepancy call backs in the AM

• TPA given with tele-neurology.

o   In-House Interventional Cath Labs

o   Average door to balloon times of 50-70 minutes (100% under 90 minutes)

• ED Physicians respond to cardiac arrests on the floor
• No holding orders written by ED
• RN to Patient Ratio: 1:4 (sometimes 1:5)
• Tech to RN Ratio: 1:2
• Splinting is done by the Physicians (for billing purposes)
• No Pysch floor -  community service board finds placement for all pts
• 10 bed ICU Unit (intensivists in-house 24/7)
• Utilize most sedation agents (except Propofol)
• 24/7 In-House Coverage for the following:

o   CT

o   Ultrasound

o   Hospitalist

o   NICU

o   Ortho

o   Anesthesiology

o   Oncology

o   Cardiology

o   Laparoscopic Surg.

o   General Surgery

o   Urology

o   Gastro

o   Pulmonary

•          In-House During the Day/On-Call at Night

o   Infectious Disease

o   Neurology

o   Oral Facial Surgery

o   Spine Surgery

•          On-Call only:

o   Nephrology (24/7)

•          Currently Lacking:

o   PICU

o   Pediatrics

o   Truama

o   Neurosurgery

o   Ophthalmology

o   Plastics

o   Cardiothoracic surgery

o   ENT

o   Hand Surgery

o   Thoracic Surgery

•          Good Lab Turnaround times
•          Point-of-Care Labs in the ED:

o   Chem Eight

o   Creatinine

o   Lactate

o   BNP

o   Hemocult

o   Gastrocult

•          Glidescope in the ED
•          Booje in the ED
•          RN Protocals used in Triage
•          Translation Phone (1 in the department)
•          Provider in Triage (APP)

o   Enables door to provider times of less than 1 minute

Also have direct-to-bed policy, which bypasses Triage if beds are available (10a-10p)

Patient Population And Department Leadership

• English spoken by 99.9% of patients
• A lot of Ortho and OB-GYN Patients
• Suburban
• EMS from Newport News City, Hampton City, York County, EMS from local military base
• 25% African American
• Majority White
• Small international community
• Some rural
  

 

• Timothy Hitchison, MD

 

 

• ED Director sits on the Medical Executive Committee