7 minute read
Dedicated to emergency medicine
In a time of unprecedented demand for emergency care, our ED staff is rising to the challenge. Driven by passion, the team now sees more than 75,000 patients annually.
To understand the capacity issues facing the Emergency Department today, “the story arc begins with COVID,” reflects David Huckins, MD, MBA, Interim Chair.
Flash back to February 2020, and Newton-Wellesley’s ED saw 165 patients a day on average. When the first wave of COVID hit that spring, volume dropped 40 percent before bouncing back a year later.
Ever since, “the increase has been unrelenting,” he says. “Over the last two years, volume has continued to build and build.”
Across his 27 years on the ED staff, Dr. Huckins has held many different roles, directing everything from EMS to research to operations. From his earliest days in emergency medicine, like many in the field, he’s appreciated how “you never have a day that you know what will happen.”
Yet nothing prepared him for the pandemic. “For the first time in my career, we had to worry about our own safety,” he shares. “Never before had I dealt with my life being in danger.”
Amid a 100-year crisis, “the team didn’t miss a beat. Everyone stepped up.”
Increasing pressure
During the post-COVID surge, all has been strained by volume. The ED staff now sees 225 patients per day on average, up by more than 35 percent since pre-COVID. On its busiest day, 256 patients sought care in a space originally designed to accommodate 150.
In explaining the impact, Dr. Huckins turns to science for an analogy: when volume increases in an enclosed space, the pressure increases.
The department has done everything it can to maximize existing space, including creating six pods carved out of space in the waiting area and using 24 stretchers as auxiliary spaces.
He appreciates how several initiatives have helped ease the pressure, such as patient progression efforts to free up beds. Ultimately, a long-term fix to space issues would require expanding the ED.
Whatever the challenge, he takes heart in the “quiet determination” of the ED staff. “Many of us have been together so long. It makes for a team that’s resilient and supportive.”
Putting patients first
Dr. Huckins credits leaders working together across the hospital—and Mass General Brigham—with helping ameliorate the problems. “The cumulative effect shows real results,” he says.
As in all facets of patient care at Newton-Wellesley, emergency medicine benefits from the hospital being part of Mass General Brigham. In January 2022, the system launched its enterprise emergency medicine service, building on a long history of collaboration and coordination across hospitals.
“The systemwide approach puts our patients first,” explains Michael J. VanRooyen, MD, MPH, chief of enterprise emergency medicine for Mass General Brigham. “Working together advances patient experience, quality and safety, and health equity across our hospitals.” It also helps in managing complex issues such as boarding and behavioral health that impact not only NWH but all hospitals today.
NWH plays a key role in the system’s capacity as Mass General Brigham’s second busiest emergency department.
Being there for kids and families
“Our connection with Mass General Brigham has always been there, but it’s grown stronger,” reflects Mollie Lebowitz, MD, NWH’s Interim Chief of Pediatric Emergency Medicine.
“We have the feel of a community hospital that’s very connected to the world around us,” she adds. At the same time, NWH has all the resources of being part of one of the world’s premier healthcare systems. “That’s a very lucky balance.”
Now in her ninth year on the team, she’s part of training a new generation of staff coming on board.
Children and adolescents account for up to a third of ED patients. As in every part of the ED, “our volume has gone up and up,” she explains. In the winter of 2022, “the huge RSV surge was the worst I’ve ever seen,” she recounts.
Whatever the day’s challenges, her love for patients and families and her wonderfully caring colleagues keep her going. “I’m extremely lucky to have a great team,” she reflects. As part of their community focus, “we have great relationships with the pediatricians in our area,” she adds. “They are wonderful!”
NWH is not only her workplace but also her family’s hospital of choice. “It’s where I brought my own two kids,” she says.
Life-saving work
Years ago, in her very first job at a local hospital, Dorothy Smith, RN, “fell in love with the ED.” One of the newest leaders on NWH’s team, she brings 40 years of experience to her nurse director’s role.
She describes the surge in ED volume as a “tsunami.” Among the many impacts of the pandemic, the stress and social isolation has spurred an influx of patients with behavioral health issues (see story, page 11). ED staff often see far sicker patients and, with people living longer, more geriatric patients.
All of this has changed the emergency nurse’s role. A natural team builder and former nurse educator, she sees one of her key goals as training the next generation of nurses.
Drawn to the hospital and system in part by their strength and stability, she appreciates not only the community feel and collegiality at NWH but also having the resources to take care of patients’ needs.
The extraordinary staff keeps her energized. It’s demanding work, even for those who thrive on chaos. Yet what they do can be life-saving. Being there for patients “feeds your soul,” she says.
An honor and a privilege
“I work with incredible people,” Justine Nagurney, MD, says gratefully, noting how many have made NWH their professional home. “They’re committed to this place and to their patients.”
She’s approaching year four at NWH, where she serves as Medical Director of Home Hospital Emergency Care. Looking ahead, “the future of medicine is in the community,” she believes. “Newton-Wellesley is unique.” Its values align beautifully with her own belief in prioritizing seeing patients where they are.
“Caring for our patients is an honor and a privilege,” she says. “I really feel lucky to be part of this community.”
New Chair of Emergency Medicine named
In July, Newton-Wellesley will welcome Erin Beaumont, MD, MHCDS, as Chair of Emergency Medicine. In her new leadership role, she will help guide the hospital’s ED in building on its commitment to safe, high-quality, patient-centered care as well as seamless coordination with Emergency Services colleagues across Mass General Brigham. A highly skilled physician, she brings deep clinical knowledge, proven leadership skills, and a passion for community. She joins NWH from the Cambridge Health Alliance, where she has served as site chief at the Cambridge Hospital ED and Somerville Campus Urgent Care.
Psychiatric triage
As the Emergency Department’s specialists in behavioral health, the Psychiatric Triage team has had to rise to its own share of challenges.
At a time of crisis in mental health nationally, having a team of psychiatric social workers embedded within the ED creates a strong resource for patients of all ages.
“We have a great team of very seasoned clinicians,” notes Maureen Lavelle, LICSW, lead social worker. “We’re all working closely together to do whatever we can to get patients the best care.” From her perspective, NWH offers one of the best consult liaison teams across Mass General Brigham.
Elliott Martin, MD, the team’s medical director, echoes her point. When it comes to ensuring patients move on to the right next step, “I can’t say enough about the job they’ve done,” he says. “Hands down, they’re the best.”
The team does an incredible job collaborating both with psychiatrists and the wider ED staff, he adds. At the same time, “this is a very psych-friendly ED,” a distinction that he deeply values.
A decade ago, the hospital’s reputation for providing compassionate care to its most vulnerable patients drew Maureen to NWH. “The ED is like a family,” she reflects. Along with taking care of patients, “we take care of each other.”
