Emergency care in the 21st century


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Getting skilled treatment quickly and efficiently can be vital.

Whether it’s treating someone suffering from a stroke with new, ground-breaking techniques or rendering potentially life-saving aid to someone with a substance misuse disorder, the region’s medical professionals are working to evolve, streamline and improve their emergency medicine practices.

From using patient tracking tools to creating more efficient health care access for people in need, Granite State providers are breaking new ground in the health care industry. We reached out to two of New Hampshire’s most prominent health care providers to learn how they are improving emergency care – both in their processes and in their facilities.


Our experts

Dr. Joseph Guarnaccia
Elliot Emergency Department Medical Director
Dean Carucci
CEO of Portsmouth Regional Hospital

Q. What new technology does your emergency room have to help streamline emergency room care?

Dr. Joseph Guarnaccia: Technology is not always the key to streamlined care. We have found that creating more efficient access to the emergency medicine providers has been one of our greatest assets.

The Rapid Triage and Treatment area embedded in the emergency department is an innovative process that allows a daily dedicated emergency department care team to diagnose and treat patients who do not need an emergency department bed. Patients are seen more quickly, they are not waiting for long periods of time, and medical care is not compromised as each patient is diagnosed and treated by an emergency department provider in an expedited manner. In the past, these patients had to allow care to be delivered to the more acute patients while they waited. Now, our approach to delivering treatment to both the seriously injured or ill and the less acute patients happens simultaneously.

Dean Carucci: We have added the new Portsmouth Regional Hospital freestanding Seabrook Emergency Room in Seabrook, New Hampshire to better serve the southern New Hampshire, Seacoast and northern Massachusetts coast. Our Seabrook- and Portsmouth-based emergency rooms both use advanced patient tracking tools to assist our clinical team with patient flow and reduce overall wait times and emergency room length of stay.

Q. How have you expanded your emergency room to accommodate more patients?

Dr. Joseph Guarnaccia: The Elliot emergency department is undergoing a $3 million renovation expansion project to both our main emergency department and to our dedicated emergency department acute psychiatric unit, also known as Psychiatric Emergency Program (PEP). The number of PEP beds planned is expected to increase capacity by 50 percent while we plan to increase our main emergency department beds by 15 percent. These increases in number of beds will help alleviate some capacity volume issues and allow us to care for more medical and behavioral health patients in need. As a community health care provider, we know reinvesting in the community through expansion such as this is critical to meeting the needs of patients turning to us for their health care.

Dean Carucci: Portsmouth Regional Hospital recently built a 10-room, 24/7 Seabrook Emergency Room that opened on June 1, 2017. Portsmouth Regional Hospital also has a Level 2 Trauma Center, including the addition of a helipad (opened in 2015) to allow for air transport. Portsmouth Regional Hospital has also added dedicated behavioral health space in our emergency room to accommodate the growing community demand for emergency behavioral health services.  

Q. What new process has been implemented to help patients?

Dr. Joseph Guarnaccia: Elliot continues to take great measures to care for those patients suffering with substance misuse disorders. Our emergency department received a grant from the Foundation for Healthy Communities to provide care and support of those patients identified as having a substance misuse disorder. In collaboration with Serenity Place, we will embed a clinician from Serenity Place within the department. In the new process, once the patient is medically cleared, an in-person hand-off will occur between the emergency medicine provider, the patient and the Serenity clinician. The Serenity clinician will then evaluate the patient to help determine what their needs are and discharge the patient to Serenity Place, as deemed appropriate, for substance misuse therapy.

Dean Carucci: Timely access to care is critical — especially so for stroke patients. Portsmouth Regional Hospital has implemented evidence-based care protocols to ensure immediate access to diagnostic and interventional stroke care, including endovascular thrombectomy.

Portsmouth Regional Hospital offers endovascular thrombectomy stroke coverage 24 hours a day, seven days a week, 365 days a year. Led by our skilled Interventional Radiology team, this life-saving treatment removes the blood clot in the brain causing the stroke, resulting in improved long-term outcomes for stroke patients.

Q. How is your emergency room evolving?

Dr. Joseph Guarnaccia: The Elliot Hospital Emergency Department is a 32-bed, full-service, Level 3 Trauma Center providing care for our patients and their families treating in excess of more than 58,000 patient visits per year. Our department is always evolving while we deliver extraordinary coverage consisting of board-certified emergency medicine physicians, nurse practitioners, physician assistants and trauma and critical care surgeons. Our trauma team is readily available 24 hours a day, seven days a week to manage and treat the traumatic needs of any child or adult in the community by board-certified or board-eligible trauma and critical care surgeons. Immersed within the department is the only pediatric emergency department in southern New Hampshire, staffed by board-certified pediatric emergency medicine physicians. Due to the demands of the community, we have an acute psychiatric unit with dedicated psychiatric nursing. And, as discussed previously, we evolve to create efficiencies that also adhere to our quality expectations and rapid triage and treatment is the perfect example of our efforts.

Dean Carucci: As one of only two Level 2 Trauma Centers in New Hampshire, Portsmouth Regional Hospital was recently verified by the American College of Surgeons (ACS) as a Level 2 Trauma Center. This elite ACS designation supports Portsmouth’s dedication to providing highly specialized critical care services.

This Q&A is part of a special advertising section that appeared in the September 29, 2017 issue of NH Business Review.

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