New Limerick ED applies ‘world-first’ design concepts for improved patient outcomes

 
 
 
 
The design and configuration of the new Emergency Department at UHL allows for earlier investigations and  life-saving interventions for critically ill patients in the Resuscitation area.
 

And daily simulation exercises in the Resus area – which is fitted out with multiple cameras –  allows emergency medicine teams train for rare, high-risk cases, providing for better patient outcomes.
 
Dr Fergal Cummins, Consultant in Emergency Medicine, said the design of the new ED included “a number of concepts that are not only a national first but firsts for Europe and world firsts.”
 
“There is no other ED in Europe that has a CT scanner in a Resus Room. We know of one in Korea but not in Europe. What does that mean for patients? It means that if a patient comes in and needs a scan, let’s say for a stroke, we can do the scan and if we find a clot we thrombolyse them immediately there and then,” said Dr Cummins.
 
Thrombolysis is a therapy providing for the delivery of clot-busting drugs in stroke patients.
 
“In stroke, we say that ‘time is brain’ and heretofore moving a patient to radiology for CT could take 15 minutes. That is no longer good enough. Now we will no longer need to bring somebody out of the department. As soon as they arrive and show features of a stroke, they are scanned and thrombolysed there and then without delay. The way the room is configured, we have the ability to bring the CT scanner on rails and wheel it over the patient; scan them and wheel it back out of the way. We can pull across the lead curtain and continue scanning somebody else in another room in Resus while continuing to resuscitate the first person. So there is a multifunctionality to this concept that you will find nowhere else in Europe,” explained Dr Cummins.
 
This feature would also provide for better outcomes for patients with serious head injuries or traumatic injuries to the body by minimising their movement.
Dr Cummins said the Resus area would also be used for simulation training with high fidelity AV equipment used to share learning across the UL Hospital Group, its academic partners at UL and further afield.
 
“The benefit of this is for those occurrences which are very infrequent but are high risk. Just as in the airline industry people have to train for rare events such as a bird strike, we must prepare for those rare events so that when they do happen, we can respond quickly and efficiently. In our case that could be an emergency surgical airway or a thoracotomy, where we would have to open somebody’s chest to try and stop a bleeding heart from exsanguinating,” said Dr Cummins.
 
“What we are trying to do is to make sure that, for our doctors, our nurses and our students, that everything is familiar. The simulations involve a manikin rather than a patient but when the patient arrives, the room is familiar, the equipment is the same and we have the benefit of all the learning around crew resource management and situation awareness taken from the simulations. The more we rehearse, the better we work as a team. It is not that the skills are inordinately technically difficult in and of themselves but the team dynamics in the high-risk, high-pressure, rare occurrence can be hard to get right. Simulations will be done every morning and we want people to be so familiar with things that they will be able to do it by rote,” he said.
 
The concept behind the simulations was “ a world-first”, Dr Cummins said, and would make UHL hugely attractive as a place to come and train.
 
“For our UL students, this is the highest level of teaching we can provide and it will be multidisciplinary across medicine, nursing and ancillary. We have already had significant interest from North America and Australia now that we have this concept that is going live. We are all hugely excited about it. It will mean a significant improvement in patient outcomes,” said Dr Cummins.