Emergency Department

The Emergency Department (ED) is a 32-bed unit that contains a triage/medical screening area, minor care area, a clinical decision unit and a registration area.

The ED also has a cardiac monitoring system consisting of 31 bedside units and three portable units with cardiac non-invasive blood pressure and oxygen saturation capabilities wired to a central scope at the nurses’ station. Special patient care requirements include capability to provide invasive monitoring, in-department radiology, ventilator co-management with respiratory therapy and emergent specialty procedures.

Patient Population

The ED exists to provide quality care to residents of Gainesville and the surrounding area for patients that are acutely ill or injured. The Emergency Department provides assessment, triage/medical screening, diagnosis and treatment to populations of all ages that present to the Emergency Department. The ED provides and supports care for Level I trauma patients in coordination with trauma services. If admission to the hospital is necessary, patient care is transferred to the appropriate admission team.

The most common nursing care activities include the assessment, diagnosis and treatment of potential or actual altered respiratory function, potential or actual altered cardiac function, potential or actual altered/impaired neurological status, potential fluid and electrolyte imbalance, potential or actual altered body temperature, potential impaired physical mobility, potential or actual altered comfort, potential or actual tissue/skin integrity and potential or actual infection. Patient and family discharge education related to the patient’s condition and treatment is an essential element in the nursing care provided.

Health Care Team

The medical director of the ED is board-certified in Emergency Medicine. ED faculty and emergency medicine, pediatric, surgical and medicine residents provide 24-hour medical care in the ED. Multidisciplinary comprehensive care of ED patients are provided by pre-hospital providers, a hospital-based Flight Transport Program, nursing, medicine, social work services, pastoral care, pharmacy, cardiopulmonary services and other health care providers as indicated by the patient’s health status and identified needs.

Nursing management for the unit includes registered nurses (RNs) in the positions of nurse manager and clinical coordinator and non-RNs as administrative supervisor and administrative assistant. The unit staff includes RNs, critical care techs and unit clerks. Additional unit requirements for RNs in the department include the completion of Trauma Nurse Core Curriculum, Advanced Cardiac Life support and either Pediatric Advanced Life Support or Emergency Nurse Pediatric Course within six months of hire to meet Level I verification requirements. The department requires RNs to attend Triage College within the first year of hire and completion of orientation to triage after a minimum of 12 months or previous documented triage experience.  Another department requirement is completion of orientation for care of critically ill patients of all ages, and the ability, willingness, and interest to work with the age appropriate and developmental needs of patients.

Critical Care Techs and unit clerks meet the basic requirements for their positions and function in accordance with their unit-based job description as described in the hospital plan of nursing care. Additional unit requirements for Critical Care Techs include training in phlebotomy, performing 12 Lead EKGs, splinting of extremities, foley catheter insertion, patient transport and a positive attitude in patient care.

Staffing Plan

Nursing care in the ED is based on the team nursing delivery model (as described in the hospital plan of nursing care). A charge nurse is assigned to each shift and is responsible for the overall operation of the shift. An RN is assigned to triage. The nurse manager and the clinical coordinator are also available for staffing the unit as needs warrant. The remaining RNs and Critical Care Techs are assigned to specific rooms or areas of the ED. A dedicated RN is assigned to the Minor Care treatment area from 10:00 am to 8:00 pm. A Critical Care Tech is assigned under the direct supervision of a RN and the ED attending. The ShandsCair Adult/Pediatric Flight team also assists with staffing from 10:00 am to 8:00 pm daily unless they are transporting patients or have flight-related duties. Minimum staffing is based upon patient census, acuity mix and availability of assisting nursing staff. Unit Clerk coverage is provided 24 hours a day and provides support for ancillary services requisitions, telephone services, and record maintenance.

The nurse manager, clinical coordinator or assigned shift charge nurse will make decisions concerning the overall adjustment of staff, either increasing or decreasing according to census/acuity. The nurse manager or clinical coordinator is responsible for coordinating patient care assignments.