This is Going to be Wonderful

The staff of the Dan Dierdorf Emergency and Trauma Center at SSM Cardinal Glennon Children’s Hospital moved into an expanded and updated building space late in January. It was the first step toward an eventual tripling of the facilities that will be available for emergency and urgent patient care at the hospital.

“Isn’t this great?” asked Anne Toenjes, R.N., as she toured the new home of the emergency room team. Toenjes is interim clinical manager of emergency services at Glennon.

“The layout will be entirely different from what we’re used to having. The space is going to be absolutely immense, with this huge, wonderful central nurses’ station. You can’t imagine how much we’re looking forward to this.”

The opening of the new emergency center entrance and building wing was the second major milestone in the current construction program underway at Cardinal Glennon. The first was last year’s opening of a new multi-level parking garage near the relocated emergency center entrance.

After the new emergency room space was occupied, construction crews moved into the old ER quarters to begin gutting that space and building rooms that will match those in the completed building extension. When that work is done in August, the Dan Dierdorf Emergency and Trauma Center will be three times its former size and contain many practical and technological features that were not possible in the old cramped quarters.

In August the hospital also will move into a new patient care wing that contains 48 private patient rooms and a new ambulatory care clinic for out-patient services.

The Glennon emergency center, which serves children and adolescents up to 150 miles from Saint Louis, is named in honor of long-time hospital supporter Dan Dierdorf. He is a former St. Louis Cardinals football star who has since become a member of the professional football hall of fame and a nationally-respected sports broadcaster. The department is classified as a Level I pediatric trauma center, meaning that it has the resources to provide immediate care for serious or life-threatening injuries and illnesses.

“When we move into all of the completed space, it really is going to be fantastic,” said Richard Barry, M.D., director of emergency medicine at Glennon and a professor of pediatrics at St. Louis University School of Medicine. “The trauma rooms are really impressive. We will have more examination rooms, and the rooms will be much bigger so we can take care of tall and large children as well as small children.”

After August, the emergency room will have 23 patient exam rooms, up from the current 12, and the rooms will be about 50 percent larger. The center will gain an additional trauma room for a total of four, and those rooms will be three times the size of those they replace.

In total, the Dierdorf center will cover about 21,000 square feet. The boost in facilities will shorten the waiting times for families visiting the emergency center and will permit the installation of many amenities that the old rooms could not handle, Barry said.

A pediatric emergency center is almost always busy, said Barry, who joined the Glennon staff in 1977. “In the summer we see fewer patients, but there is much more trauma. Once the kids get back in school and come in close contact with each other, we see more infectious diseases. In the winter, it’s respiratory illnesses, viral infections and influenza. And asthma is a year-round thing.”

The pace picks up in the emergency room as each day progresses, he said. “The busiest time is 7 to 11 each evening, and 11 at night to 3 in the morning is not far behind. During the winter there can still be kids in here getting breathing treatments at one or two in the morning.”

During peak times, patients can wait several hours for assignment to an exam room because no rooms are available, Barry said. “During evening hours the waits can be tremendously long because rooms are occupied by patients who are requiring fluids, breathing treatments and other procedures. We have patients who have been triaged but we can’t take care of them because we don’t have any rooms for them. After August the experience should change dramatically.”

Representatives of the emergency room staff and other hospital departments that contribute to emergency care have been meeting to determine how to achieve a new standard when the entire ER suite is in use.

“The goal is faster access to care. We will try to meet a ‘30/30’ standard called ‘excellence in response.’ The goal is seeing patients with life-threatening issues within 30 seconds,” Barry said. “For other patients, the goal is that they will be seen by a physician or will have therapy started within 30 minutes of arriving.”

The emergency center was last updated in 1978, when there was much less technology in the typical emergency room and teenagers didn’t seem to be so large.

“The old ER was built in 1978 to handle about 18,000 patient visits a year,” said Toenjes, who has worked at Glennon 24 years, the last 15 in the emergency center. “We’re seeing 39,000 patients a year. Needless to say, at some point we reached maximum capacity.”

Some of the previous examination rooms were too small to accommodate all the equipment and supplies needed to care for patients who needed sedation for procedures such as lumbar punctures or the suturing of lacerations. That caused further delays for patients.

“In the past we had to wait for a trauma room to become available before we could do some procedures. All of the new rooms will have full monitoring, overhead lighting and suturing capabilities, and that will make a big difference,” Barry said.

“The technology has changed so much in the past 25 years. We have much more non-invasive monitoring, things like pulse oximetry, which enable us to put a probe on a child’s finger to monitor oxygenation. The monitoring equipment is more compact, so it can go where the patient goes.”

Another recent innovation is a portable blood analysis machine that can complete tests that used to be handled in the lab down the hall. “For our trauma cases they can come to the bedside, take a blood sample from the patient and within two or three minutes the result is printed out right there,” Barry said.

The trauma rooms will more easily accommodate the 10 physicians, nurses and technicians who respond to a trauma call. A mobile boom suspended from the ceiling can be positioned directly over the patient to place monitors, oxygen, suction, computer data ports and a telephone within immediate reach of caregivers.

“The trauma rooms are where we take care of the sickest and most seriously-injured children, the kids who have been in bad accidents or are in respiratory distress,” Toenjes said.

The hospital’s ambulance doors are now located around the corner from the entrance for less seriously ill patients. The trauma rooms are just a few feet from the ambulance doors, which are a short distance from the helicopter landing pad. Two private family lounges share a hallway with the trauma rooms.

Some related hospital facilities are being relocated to improve care in the emergency department. When the current renovations are completed by August, the hospital’s diagnostic imaging facilities will be moved to space immediately adjacent to the emergency center. Currently, patients must be transported to another part of the hospital’s ground floor for x-ray, CT or magnetic resonance imaging (MRI) examinations.

“Our imaging capabilities also have improved tremendously. In the early ‘70s we didn’t have CT (computed tomography) scanning, and when we did get it, a CT scan took 20 minutes. Now that time is down to minutes or seconds. That is really nice because most kids will hold still for that little bit and we don’t have to sedate them.”

Last fall Glennon became just the third hospital in the St. Louis area to acquire the latest generation of computed tomography technology, the Lightspeed CT scanner from GE Medical Systems. Glennon is the first free-standing pediatric hospital to install a Lightspeed scanner. Fewer than 100 are in use in North America.

The first multiple-slice CT scanner, the Lightspeed can simultaneously capture multiple images of patient anatomy and can acquire more detailed images more quickly than previously possible. Some scans that required three minutes of exposure with older CT technology may take as little as 20 seconds with the Lightspeed, which can be used to image the spine, head, abdomen and chest.

An increased number of computers in the emergency center will further speed patient care by enabling doctors and nurses to more quickly read laboratory results and x-rays, write orders for tests and procedures and send reports to referring physicians. It also will be possible for patients to be registered at the bedside if an exam room is available when they arrive, Barry said. “They won’t have to sit in the waiting room at all.”

All of the department’s physicians will carry a portable telephone while on duty so they can quickly be contacted regarding lab results, patient orders and calls from referring physicians. “Instead of relying on announcements over a public address system in a noisy environment, we can make a phone call. That will make the emergency room quieter and we will have better, swifter communications,” he said.

All exam rooms will be equipped with televisions, to keep children occupied while waiting for their care to be completed. Families will find more room in colorfully decorated waiting areas that will be configured in pods so infectious patients can be separated from other children.

There also will be four examination rooms and an internal waiting area for patients of referring physicians who call ahead to let the staff know the children will be coming and what care they will likely require.

HOW TO ENTER THE NEW EMERGENCY DEPARTMENT

The department’s nurses will have considerably more space too for handling administrative responsibilities. The current nurse’s station is a corner counter with enough room for one person to do paper work. The new nurse’s station will stretch along a whole wall of the unit.

The new facilities were designed with input from the entire emergency room staff.

“We had a group that met with the architects from the beginning,” Toenjes said. “As plans were drawn we would put them up in the nurses’ lounge and solicit ideas. The layout of the rooms, accessibility, security and safety were big items.”

Exam rooms were designed with plenty of storage cabinets and room for wheeled supply carts under countertops. A team of nurses decided how supplies should be arranged. “You’ll be able to go into any room and know exactly where everything is,” she said.

The scheduled completion of the entire Dierdorf emergency center will be accompanied by the opening of the patient care wing being constructed south of the main Glennon building. The wing will hold a new ambulatory care center for outpatient visits and 48 inpatient beds. Those beds will be relocated from existing hospital units. Upon the opening of the wing, construction work will continue on existing hospital units to convert all of the hospital’s inpatient rooms to private, single-bed configurations.

The availability of more private rooms will enhance care in the emergency department by making it easier to promptly admit patients, especially those who have infectious diseases and need to be isolated.

“Sometimes there are no beds upstairs for those patients, even though some rooms are only half-full,” Barry said. “Having the new rooms in the tower will be tremendously helpful.” “This is going to be wonderful,” Toenjes said. “For those of us who have been here a long time, it doesn’t seem like this is really going to happen.”