About Emergency Care
Life Is Unpredictable
You can rely on us to be close when you need us. At Penn State Health St. Joseph, we’re equipped to handle a wide array of emergency situations.
Our emergency department provides full emergency services, 24 hours a day, seven days a week. For the most urgent emergency situations, critical patients can reach the emergency room in minutes by an ambulance by calling 911.
When to Visit the Emergency Room
Chest pain, strokes, head injuries, broken bones. How do you know where and when to go? Not sure if you should visit the ER, go to Urgent Care, or schedule an appointment with your doctor? We tried to make it a bit easier for you to decide.
Preparing for an Emergency
- Keep an updated list of all medicines, including the doses and the time of day they are taken
- Be specific in explaining the problem and symptoms, including when they started and if they have changed
- Provide name of family doctor
- Be ready to give relevant health history, i.e., has this occurred in the past, when, for how long.
- Answer the questions in detail, but briefly. While the nurse is listening, they are also observing the patient’s speech patterns, the logic of their thought, their eyes and breathing.
- Never withhold information; often what is not said is critical to diagnosis and treatment.
What to Expect
Speed balanced by Quality and Thoroughness
Wait times are singularly the biggest concern voiced by the public when they seek care in an Emergency Room , any Emergency Room (ER). Fast food can be delivered in 60 seconds and flu shots are given in drive by clinics, why can’t Emergency Care be faster?
At Penn State Health St. Joseph, we know the goal is to have care delivered quickly. While our wait times are far shorter than many hospitals, focusing on speed for speed’s sake is a problem. We must balance the need to get the care right with the desire for speed.
It all starts at Triage
At St. Joseph, as more and more people select our ER for their care, the pace and complexity of the care is enhanced by the collaboration of our ER staff with ancillary services. For each person that selects St. Joseph for care, there begins an enormous investigatory process that is undertaken for each patient no matter their ailment or injury. And that process starts with the Triage Nurse.
Triage nurses are experienced Emergency Nurses who have received special training to rapidly assess and “sort” patients based on their medical condition. The triage nurse follows the standards for care established by the American College of Emergency Physicians and the Emergency Nurse’s Association. All patients are evaluated and assigned an ESI level (Emergency Severity Index) which determines the level of care required for the stated illness. This will determine in what order you will see the doctor. Surprisingly, or maybe not, Triage nurses find that many people who seek ER care, perhaps a little less than half, actually do not need the full services of an Emergency Room. This little, but critical piece of information has begun to transform the Emergency process at St. Joe’s.
Creation of SUPERtrack
When people don’t need the full services of the ED, we bring the care to them – very close to the front door. This type and level of care is called SupERtrack. For many, their care can begin immediately.
How it works
As patients come into the St. Joseph ED, they are met by the Triage staff. If they are not acutely ill – such as a heart attack, stroke or other critical, life-threatening problem – they may not require the full services of the ED. The patient is taken to a treatment room where medical staff provides care. The patient is discharged directly from that area.
When tests such as x-rays or blood work are needed, the patient returns from the study to the “results are pending” or RAP Area, next to the SupERtrack. They remain in the RAP Area until test results are known. If the results are normal, the patient is discharged.
Patients should not eat or drink anything while waiting for treatment. Food may interfere with medications or test preparations, which may delay care. A vending area is located in the main waiting area alcove for visitors. The cafeteria is located on the ground floor.
More communication, additional beds for the seriously sick
Board-certified emergency doctors are assigned to specific ED areas, increasing their availability to patients, staff and communication from primary care doctors and specialists that are often so critical to determining a proper diagnosis.
When patients with life-threatening conditions or those requiring help to manage chronic health problems, such as heart problems, diabetes, asthma, or high blood pressure, present to the triage nurse, they will be sent directly to the acute treatment area. Patients before them with less critical issues may have to wait. While this may seem unfair, it is necessary as some patients are more actually ill than they appear. The triage nurse is trained to recognize these subtleties.
The ability to pay for services or the type of insurance has no effect on the order that patients are evaluated. Patients that experience a delay because a bed is unavailable may have initial tests done while they are waiting, including blood work or x-rays. Beginning the testing during this time may shorten the length of time in the ED.
Patients are registered, usually in the treatment area. The staff will ask questions concerning the patient’s name, birth date, social security number, medical history and insurance information. Any required copayment is collected at time of discharge. Patients are given a copy of their patient rights and sign a consent for treatment form, as well as a confidentiality policy (HIPPA), verifying they received the information.
Is it a heart attack, angina, indigestion, stroke, or a bad burrito?
In emergency medicine, doctors and staff are trained to rule out the worst causes first. As a Certified Chest Pain Center and Certified Stroke Center, St. Joseph follows strict protocols to eliminate life-threatening causes of chest pain or provide emergency treatment for stroke. Strokes can be very debilitating, but specialized treatment to preserve function can be provided within a small window of time from the beginning of symptoms. Opening blocked arteries quickly may mean saving lives – we do them faster than the national standards.
Once a patient arrives in the treatment area, a nurse, physician or physician assistant will examine them. The team, in conjunction with the patient, will determine the individual plan of care. Questions are welcomed.
Tests may be ordered to gather important information. This usually takes between two and three hours, and delays will be communicated to the patient. Delays may occur due to the number of patients, preparation for tests or the type of test required. Nurses spend the time between patients documenting everything they observe, administer and do for a patient by way of the computer. This ensures that all caregivers have immediate access to the care that was provided. A call bell is available if the patient needs anything.
Re-Evaluation and Decision Time
When all the test results have been reported, the physician or physician’s assistant will review them with the patient, and discuss the discharge or admission plan of care.
Getting Admitted to the Hospital
When the ED physician recommends a patient be admitted, they will be evaluated further by another physician to define the long range plan of care. The patient will then be transferred to the appropriate inpatient nursing unit. When a bed isn’t immediately available, the patient may remain in the ED until one becomes available. Their care will continue as prescribed by the admitting physician. If a patient requires specialized care outside of the realm of an acute care setting, they may be transferred to a specialized hospital.
Or Getting Discharged from Emergency Care
If a patient’s condition has improved enough to be discharged while in Emergency, they will be provided with home care instructions, which may include medications, treatments and the need to follow up with the family doctor. Staff will provide information concerning family physicians for those without a family doctor.
If discharge instructions require follow- up with a specialist and the patient’s insurance requires a referral, this will need to be obtained from their family doctor. Insurance companies will not permit Emergency doctors to make the referral.
The Emergency Department (ED) Navigator may become involved in discharge care, reviewing medications and instructions, and answering questions. For patients with chronic or high risk diagnosis, the navigator may assist in setting up office appointments, coordinating outpatient services or by calling a patient after discharge to follow up on their care. They may assist any patient that is having difficulty complying with their instructions.
Patients will receive two separate bills for services in Emergency; one from the medical center for emergency services, and the second for the services of the TeamHealth physicians, who staff our Emergency Department.
Those having imaging studies will also receive a bill from the radiology department.
Each bill will have phone contact numbers for additional questions.
Patient safety is of utmost importance. Patients may be asked the same question multiple times – be assured that staff communicates with each other; however, everyone involved in care is committed to providing care safely. Safety measures may include keeping side rails up, assisting with bathroom needs, restricting activity after certain medications and verifying identity before drawing blood, giving medications or performing tests.
When shifts change, nursing personnel will come to the bedside to discuss the patient’s progress. This provides an opportunity for the patient to be involved in their care, ask questions and provide feedback to the staff. That also assures the patient the new nurse knows why they are in the ED and the plan of care. Staff also checks in periodically to evaluate pain and assess needs.
Visitors will be permitted to remain with the patient in the ED exam rooms. They will not be permitted to accompany patients for diagnostic tests, such as x-ray, CT scan or ultrasound.
Based on the patient’s condition and the activity of the unit, visitors may need to be limited or restricted at the discretion of the medical staff. Patients preferring to remain anonymous during their visit should communicate that to staff so they may respect their wishes. Small children must have an adult escort.
Tell Us About Your Visit!
We are committed as a team to providing you with a safe, quality experience, and to make improvements based on feedback from patients. Patients are welcome to contact the nurse manager or medical director to express their thoughts regarding their care and safety during their treatment in the Emergency Department. Our Patient Advocate is available for serious concerns. You may call 610-378-2675 610-378-2675 or email DSantiago@pennstatehealth.psu.edu. If you’d like, take a short online survey or email us at Info@TheFutureofHealthcare.org
Survive. Don’t Drive!
Heart Attack and Stroke Are Medical Emergencies. Dial 9-1-1
If you or a loved one experiences any of the signs of stroke or heart attack listed below, immediately dial 9-1-1. Do not attempt to drive to the hospital.
- 911 dispatchers are trained to locate you quickly
- Emergency Medical Services (EMS) can diagnosis a heart attack by using an electrocardiogram (ECG) and also initiate early treatment
- EMS is able to radio ahead to the St. Joseph Medical Center Emergency Department (ED) that you are on your way. The ED physician and staff are ready for you when you arrive through the doors.
Every minute that a person delays in getting medical treatment increases the likelihood of damage or even death to heart muscle.
Signs of a heart attack can include:
- Chest discomfort, often in the center of the chest. The discomfort lasts for more than a few minutes or it may go away and come back. The discomfort may feel like pressure, squeezing, fullness, or pain.
- Discomfort in other areas of the upper body. This may include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
- Shortness of breath may occur with or before chest discomfort.
- Other symptoms may include breaking out in a cold sweat, nausea, or light-headedness.
Treatments for heart attack are most effective when they occur in the early stages of chest pain.
Heart attacks are often viewed as a man’s problem. But more women in the United States die of heart disease each year than men. Women often experience signs and symptoms that are different from those that men experience.
Heart attack signs in women sometimes go unnoticed.
They include the following:
- Pressure, fullness, squeezing pain in the center of the chest, spreading to the neck, shoulder or jaw.
- Light-headedness, fainting, sweating, nausea, or shortness of breath with or without chest discomfort
- Upper abdominal pressure or discomfort
- Lower chest discomfort
- Back pain
- Unusual fatigue
- Unusual shortness of breath
Use FAST to help understand when a stroke occurs.