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November 2006 Issue

Art Pancioli, MD, (right) works with a second-year resident to stablize a patient in the emergency department.
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The Emergency Department: Is It Like What You See on TV?

Published November 2006

Medical dramas like “ER” and “Grey’s Anatomy” give viewers a glimpse into what emergency physicians and surgeons deal with in the hospital—but are they realistic?


“The accuracy of medical TV shows varies dramatically,” says Arthur Pancioli, MD, associate professor and vice chair of emergency medicine. “They’re sometimes so realistic that I feel like I’m at work, and other times they’re so unreal they’re ridiculous for me to watch.”


“The contributing producers for ‘ER’ are medical faculty from the University of Chicago,” explains John Deledda, MD, assistant professor and director of clinical operations for emergency medicine at UC. “A lot of the cases you see on ‘ER’ are real and submitted by hospitals across the country.”


But, Deledda cautions, “Even though they’re real, you have to remember they’re dramatized.” There are some aspects that are very real—patients who present a variety of symptoms, a fast-paced environment, a high volume of patients and physicians caring for up to 20 patients each at a time.


“There’s such a diversity of patients and cases that come into our emergency department,” says Pancioli. “I think it’s wonderfully challenging to see acutely ill patients, to initially have no knowledge of what’s wrong with them and then to successfully diagnose and treat them.”


If you ask any emergency physician what a typical day is like, the resounding answer is “no day is typical.”


“On a recent Saturday afternoon at 3 p.m. there were a total of 60 patients here all at the same time,” says Pancioli. “A week before, in the same emergency department at the same time of day, there were 130 patients. There’s no way to predict what the day will bring.”


When patients arrive in the University Hospital emergency department, whether they walk in or come by ambulance, a triage nurse takes their vital signs and assesses their condition. The most critical patients are seen first.


“People can receive care in the emergency department 24 hours a day, 365 days a year,” says Pancioli. “We truly want to provide the best possible care to everyone, but unfortunately it can take longer than people might think.”


According to Deledda, patients who are diagnosed, treated and released spend an average of four to five hours in the department.


“People don’t realize that this is actually a quick turnaround. It’s not uncommon to spend up to 24 hours in the emergency department at some inner-city academic hospitals,” says Deledda.


“One thing that will never change in an emergency department is that we have to see the sickest patients first,” says Pancioli. “If someone comes in who is truly unstable and could possibly die, we have to focus on them, so patients with less serious symptoms, unfortunately, have to wait.”


To help decrease patient wait times, University Hospital has implemented an extended triage area. When a patient requires lab work or tests like X-rays for conditions such as a hand or ankle injury, nurses can save time by ordering the tests themselves before a physician sees the patient. University Hospital is also working to decrease wait times and overcrowding by improving communication between all hospital departments.


“If the emergency department was experiencing overcrowding, it was up to us to find a way to solve the problem while providing the best patient care,” says Deledda. “Departments like ours and inpatient services work together more closely now so we know what challenges we may be facing on any particular day and what we’re dealing with.”


University Hospital is the only level 1 trauma center in Greater Cincinnati. That means it has specialized physicians and surgeons, anesthesiologists, nurses, operating rooms and resuscitation equipment available at all times to treat life-threatening injuries from such frequent events as car accidents.


“It’s a misconception that what we mostly see are violent injuries like gunshot wounds and stabbings,” says Pancioli. “Our most common source of significant trauma is car accidents. With regard to total visits we see a tremendous number of heart and respiratory problems, broken bones and sprains and infections such as abscesses.”


According to Deledda, the expertise of emergency physicians has expanded over the years.


“We see nearly 80,000 patients a year in the emergency department at University Hospital. People know they can always come here and receive care regardless of the time of day or whether they have insurance,” says Deledda.


“Some people use the emergency department as primary care because it may be difficult for them to get an appointment with a doctor,” Deledda explains. “If people feel they have a problem that needs to be fixed now, they should come and see us. If these are symptoms they’ve had for a while or they have simply run out of their medication, it’s best for them to see their primary care doctor.”


“Unlike primary care providers,” adds Pancioli, “we don’t see patients on a regular basis. They do a much better job of long-term management of a patient’s health than we possibly could.


“Providers who follow patients through chronic conditions like arthritis, high blood pressure or asthma can provide an individual focus and long-term treatment.”


Deledda says there are things a patient should know to help emergency physicians provide the best care.


“Tell us what medications you’re taking and the doses,” he says, “and the name of your primary care doctor so we can collaborate to develop a better treatment plan.”

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