UPLAND - In just a few moments, the emergency room at San Antonio Community Hospital can go from relatively quiet to being jam-packed with those needing care.
"We have a very busy ER," said Vince Leist, the hospital's vice president and chief operating officer. "We saw 67,000 people (in 2007) when we have the capacity of 30,000."
After mentally tallying the space in the facility - 19 licensed emergency beds and eight to 10 overflow spaces where patients sit on portable beds at numbered spots along the walls - registered nurse Kevin Norris put it more bluntly.
"We need a new ER," he said.
Hospital officials are familiar with the growing problem of shrinking space. Plans call for a 52-bed emergency department expansion beginning in 2009.
Leist is in charge of the plans - called the Tower Expansion - which include more patient beds.
"We do know we need to expand," he said.
In the meantime, some relief is on the way.
Construction has begun on the expanded ED/South, an addition to the emergency department that will provide eight additional beds and is expected by March.
Additional staff will be hired to cover the extra beds, and more shifts will be created to accommodate patients.
Three-quarters of patients at the hospital are seen through the emergency room, partially explaining the long stays people sometimes experience in the waiting room, Leist said.
To ease those waits, Leist said hospital officials hope to implement a care-provider program in the ER waiting room. Providers would check on patients who have non-life-threatening situations, provide ice packs and other symptom-relieving aids, check vital signs and talk with family members.
"People need to understand that when they come in to see us, they need to have confidence to know that we're doing what is best for the individual (who) asked us to care for them," Leist said.
Nurses and doctors in the ER said no matter how many beds or staff they add, some patients will still have to follow after others who have more serious problems.
"We are in a worst-come, first-served business," said Karl Van Allen, an RN in the ER and a nurse educator.
Van Allen explained that patients are escorted through the ER doors by order of how sick or hurt they are and how long they have been waiting.
"There are hospitals in the local area that have wait times from 12 to 20 hours - us included," said Dr. Kevin Parkes, the ER's medical director. "We decided we don't want to do that, that waiting 12 hours isn't acceptable."
Parkes said physicians and nurses are anxiously awaiting the extra beds because that will be "eight more places we can see patients and eight less people we'll see on the walls."
Sections on the ER walls are numbered and designated for overflow beds. Staff uses them as regular stations, even setting up portable curtains for privacy, when they need more space.
"I hate that, but (patients) are getting safer and better care than sitting in the waiting room," Parkes said.
Although they have had the help of fairly new computer systems that keep ER staff better organized as well as additional employees to help out with patients, Parkes said there is still one more thing that would make his job easier.
"My biggest problem is just space. That's truly the biggest thing we need, physical space," he said. "Our volume has outgrown our physical space."
That's evident when business suddenly picks up. A relatively quiet ER waiting room populated by a handful of patients awaiting care can suddenly become jam-packed, the initial trickle of patients becoming a torrent inundating the small facility.
Staff members immediately change their demeanor as they adjust to the influx. Some hustle to prepare empty beds for incoming patients, while others clear space for the overflow.
The ER eventually calms down again as patients are comforted or cleared out.
This is the nature of the beast, said many employees - and is why they love coming into work.
"It's 20 (minutes) to 12 and I have no idea what's gonna happen at noon," Van Allen said during one of his morning shifts. "I love that."
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