“A lot of people refer to the emergency department as controlled chaos,” says Foster, director of nursing for acute care at Lexington Medical Center, which this year is celebrating 40 years at its current location. “It can be chaotic, but we are trained and ready for the patients.”
Thanks to advanced technology and professional staffing, those who work in the Lexington Medical Center emergency department say they are ready when members of the community need them. The department averages about 38,000 patient visits a year with staff that includes board-certified emergency medicine physicians and 24-hour access to specialty physicians.
Nurses in the department carry multiple certifications in advanced cardiac and advanced pediatric life support, and in trauma and emergency pediatric nursing.
Staffing wasn’t always this thorough. Karl Bolstad, MD, an orthopaedic physician who joined Lexington Medical Center at about the same time the current medical center opened in 1979, remembers how it was 40 years ago, when one nurse would staff the emergency department for much of the time. Before that, at the hospital’s old Weaver Drive location, he says the physicians all lived close enough they could be at the hospital on a moment’s notice.
“When the hospital first opened, there were four exam rooms and five beds in the emergency room,” Bolstad says. “Now, it’s 13 rooms plus a Fast Track area, which is another eight rooms. Capacity is much greater, and it’s more than one doctor at a time.”
The Fast Track service treats minor illnesses and injuries. Hours are Fridays, Saturdays and Sundays from 8 am to 1 am and Monday through Thursday from 10 am to 10 pm.
The biggest changes, though, may be in technology and services.
“When I first started, we had all the basic services covered—cardiology, general surgery, orthopaedics, pediatrics, ophthalmology and others—and since then we’ve expanded,” says David Holder, MD, the department’s medical director who joined Lexington Medical Center in 2011.
“We now have telepsychiatry services to give our psychiatry patients care while they’re in the department. We have teleneurology services so that acute stroke patients can get seen by a neurologist within minutes of arrival. We have pediatric hospitalists now who are in-house 24 hours a day to handle any child who is admitted.”
The telepsychiatry and teleneurology services use video and computer connections to allow specialists in other Wake Forest Baptist Health locations to assess patients to determine the most appropriate care. For example, the service helps acute stroke patients quickly receive IV tPA to help save lives and limit stroke damage. IV tPA is the only approved treatment for patients with acute ischemic stroke.
CT perfusion scans are another valuable technology now available.
“You can see what areas of the brain are affected by the stroke, the areas where there is dead tissue and where there is salvageable tissue,” Holder says. “That can help show the extent of the stroke and help determine if they are a candidate for an additional intervention at Wake Forest Baptist, where they can either inject blood thinner directly to the clot or manually remove the clot, which can be much more effective.”
Foster says such telemedicine services allow more patients to get the care they need without leaving Lexington. If they must leave, there’s now a helipad for fast patient transport to area trauma centers plus access to additional resources.
“Thanks to the working relationship with Wake Forest Baptist and the health system, we have access to services that we may not have had before, right at our fingertips,” Foster says. “Even if the physician or the service isn’t here, we’re able to reach out to a colleague in Winston-Salem or High Point to make sure that the patients get the care they need and deserve.”