May 15, 2014
Every day, some of the nation's most critically ill and injured patients come through the U-M Health System's adult emergency department. Once emergency medicine teams stabilize them, most head for an operating room or directly upstairs to one of U-M's six specialized adult intensive care units.
But soon, these super-critical emergency patients will get an even higher level care from the moment of arrival through the first crucial hours, all within the emergency department, in a project approved Thursday by the Board of Regents.
The new Emergency Critical Care Center, or EC3, will be among the first of its kind in the nation when it opens in two phases starting in spring 2015. Through close partnerships between the emergency department and ICU teams, it will ensure patients a smoother transition to the next phase of care.
The EC3 may mean some patients can get through an initial health crisis without needing an ICU bed at all. That's an important goal given the high demand for U-M ICU care and the ever-growing number of patients coming to U-M hospitals.
Designed with research in mind, the EC3 will make it easier for teams to test new diagnostics, devices, monitoring equipment and treatment strategies. The results of such studies could benefit patients worldwide who suffer strokes, sepsis, hemorrhages, brain trauma, cardiac arrest, overdoses and acute lung injury.
The new facility will also serve as the training ground for a new breed of emergency critical care physicians. This rapidly growing discipline involves post-residency training merging the skill sets of critical care with emergency medicine, giving doctors expertise focused on the first hours after the onset of a major health emergency.
Key facts about EC3
The $7 million project, designed by architectural firm Niagara Murano, will transform part of the University Hospital Emergency Department to create the 7,800-square-foot EC3. It will use space that served children before the opening of the pediatric emergency department in the new home of C.S. Mott Children's Hospital.
With five resuscitation/trauma bays and nine patient rooms, the EC3 will give teams of doctors, nurses, respiratory therapists, pharmacists and others room for patients' initial diagnosis and stabilization, and an ICU-level environment for initial care.
The EC3 will help UMHS meet a growing demand for emergency care, which has risen 24 percent in five years. The number of patients admitted to U-M ICUs from the emergency department has risen 10 percent a year for at least the last five years, and the amount of time such patients wait for an ICU bed has grown.
In all, about one-third of all patients who come to a U-M emergency department get admitted to a U-M hospital bed. This includes thousands who other hospitals transfer to U-M because of their critical illness or injury — including those flown on U-M's Survival Flight helicopter and jet service.
"We are seeing a growing number of complex critically ill and injured emergency patients who require time-sensitive diagnosis and treatment in order to achieve the best outcomes. EC3 will give us an environment where we can deliver the right care at the right time, beginning as soon as the patient arrives in the ED," says Dr. Robert Neumar, chair of the Medical School's Department of Emergency Medicine.
Jennifer Gegeheimer-Holmes, director of emergency department operations, notes that teams have been working together to develop new protocols for diagnosing and treating specific types of patients, and for measuring the effect EC3 has on patients' outcomes.
"We even used full-scale mock-ups of the new space to ensure the design and equipment of resuscitation areas and critical care rooms will meet all needs for patient care and safety," she says.
Dr. Kyle Gunnerson, the U-M emergency physician and critical care specialist who will lead the EC3, says, "We have a window of a few minutes to a few hours to diagnose and treat these patients, so having cutting-edge ICU infrastructure with critical care expertise in the ED will preserve precious time and perhaps shorten their overall hospital or ICU stay. As we seek to push this type of care forward through innovative approaches and technologies, the EC3 will act as a test bed of new ideas."
Advancing emergency critical care through research
Many of those ideas will come to the EC3 through the Michigan Center for Integrative Research in Critical Care (MCIRCC), which brings together more than 100 U-M scientists and clinicians with early-stage entrepreneurs and industry partners to develop and deploy critical care solutions.
Headed by Dr. Kevin Ward, MCIRCC is working to forge novel partnerships across U-M and with companies to accelerate the commercialization of new prevention, diagnostic and therapeutic products to improve the care and outcomes of emergency and ICU patients.
U-M already has many emergency research clinical trial efforts under way, and serves as the hub for multihospital clinical trial networks including the Neurological Emergencies Treatment Trial network, Michigan StrokeNet, and the Pediatric Emergency Care Research Network. The U-M Injury Center is one of only 11 funded by the Centers for Disease Control and Prevention. Having EC3 may help U-M attract funding for more programs.
By ensuring closer connections between emergency and intensive care staff, the EC3 will help ensure that patients who qualify for a study will be identified and enrolled, before hours slip by or they receive care that might make them ineligible.
Training a new kind of emergency specialist
As the options for treating critically ill and injured patients in their crisis hours grow, so does demand for physicians who have special training in such care. Already, a growing number of young physicians who have finished their emergency medicine training are opting to pursue additional fellowship-level training in critical care.
These two-year programs make emergency medicine-trained doctors eligible to be board certified in critical care, a recent change by the American Board of Medical Specialties.
UMHS emergency critical care fellowships through the departments of Anesthesiology and Internal Medicine begin this July, and the EC3 team also plans to become a training ground for other U-M critical care physicians-in-training and specialized emergency critical care nurses.