Sarasota Health News

In North Port, practicing emergencies

A medical team at Sarasota Memorial's new North Port emergency room performs CPR and intubates a robotic pediatric simulator in a scenario of a child that nearly drowns in a bathtub. The ER staff went through a series of tests Monday to prepare for Tuesday's opening.

David Gulliver - posted 5:30 p.m. Tuesday, Sept. 1

Sarasota Memorial Hospital’s new North Port emergency room handled two births, a nearly drowned baby, a patient with a stroke and another with a heart attack -- all before lunch Monday.

And that was a day before it opened.

The flurry of cases was a series of elaborate simulations, designed by the ER leaders to test the staff’s skills, the equipment’s readiness, even the stocking of supplies before patients begin rolling in today. Staff knew the general nature of the cases, but none of the details and complications.

It started at 10:08 am, with Maribeth Desiongco in a wheelchair, hysterical and hollering, eight months pregnant and about to deliver. “Is this your first baby?” a nurse asked. “No, it’s the second one,” she screamed. “I should have stopped at one, it hurts so bad!”

Desiongco, a nurse, clinical educator and real-life mother of three, saw her role end at the door of treatment room 17, where a robotic medical mannequin lay on a bed, its belly swollen, a baby crowning.

As seven nurses, technicians and a respiratory therapist crowd in, Suzanne Casey, a 16-year veteran of the main hospital’s labor and delivery unit, started dishing out pointers. “A lot of times the patient gets a little combative. There’s so much anxiety,” she said.

They ask if the patient has any pre-existing conditions, any obstetrical problems. Casey reviewed the instruments and trays. Annette Freidhof, a nurse who has managed the main hospital’s ER and now will work in North Port, coaches their patient. “You’re going to be feeling a lot of pressure... you’re going to be pushing through this,” she said. In 19 years of the emergency room’s night shift, she said later, she saw just one delivery.

Then the baby arrives, in somewhat of a tangle. “What we want to do is gently stretch the cord over the baby’s head,” instructs Debbie Dietz, a labor and delivery nurse for 18 years.

And then they have him. “The best place for the baby is up here on the mother’s chest,” Dietz tells them. “You wouldn’t believe how quickly they pink up on the mom,” Casey says. They move the baby to a portable warming unit. It’s 10:22 a.m., and Dietz and Casey run through the post-delivery concerns and field questions for another half-hour.

The ER looks much the same as that of the main campus. Its 21 observation rooms include some specially outfitted for trauma, labor and delivery, ear, nose and throat problems and mental illness.

It cost some $20 million to build, and like many ERs will lose money -- an estimated $4 million in its first year. Emergency rooms have enormous staffing costs -- being open 24 hours a day and prepared for anything -- and are the primary source of care for the uninsured and poor who cannot pay their bills. (While Sarasota Memorial's overall bad debt fell about 7 percent from 2008 to 2009, the ER's share rose about 5 percent in that time.)

But an ER can earn back much or all of those costs if it generates enough admissions to the main hospital. It is modeled on a similar facility in Ocala that broke even in five years. Another part of the building includes highly profitable MRI and CT scanners, and officials were surprised to have eight appointments already booked before opening.

But even if the ER never turns profitable, Gwen MacKenzie, the hospital system’s chief executive officer, said building it was the right thing to do.

“We have a responsibility to that community. There are 50,000 people who live there, and our commitment is to provide the care that is necessary,” she said.

North Port residents have wanted their own hospital for three decades, even delivering some 22,600 letters to Tallahassee in 2003 supporting their drive. The next year, they seemed to have fulfilled their goal when state health planners gave their required approval to one of two competing proposals. But other hospitals appealed the ruling, and a judge reversed the approval. No one has tried to build a hospital in North Port since then.

The ER is no full-fledged hospital, but hospital system officials have described it as a building block. If hospitals again compete to build there, Sarasota Memorial’s existing presence should give it an edge over other applicants, MacKenzie said.

For now, the facility is capable of handling almost anything on its own, as staff soon learned.

At 11 a.m, another staffer dashed in, shrieking that she only turned her back on her baby for a minute. He somehow slipped from a bathtub seat and now is not breathing. He has been down for about four minutes.

In the treatment room, Dr. Bill Colgate, the hospital system’s director of emergency medicine, is on hand with another team of nurses and technicians. On the bed is the hospital’s pediatric simulator, a baby-sized version of the robot down the hall.

They quickly assess the situation: no breathing, no pulse. They start CPR and administer oxygen and place an IV for medication. Then comes the morning’s only glitch. The crash cart has no pediatric respiratory equipment. A technician scrambles and finds it, and the team inserts a breathing tube. They find out later that one crash cart had been fully stocked, while theirs was not yet finished.

With the medicine given and breathing tube in place, the baby’s pulse and respiration return. They call for a chest x-ray and bring the baby’s temperature up with warm blankets, and then call for helicopter transport to All Childen’s Medical Center.

Meanwhile, Desiongco was again hollering down the hall as the second ER team started its delivery simulation. And minutes later, the first team went back to work as Keri Hockett, the system’s director of education and research, came in with clinical educator and “husband” Ron Bass.

Colgate and team quickly diagnosed the unresponsive Hockett with a stroke, and wheeled her to the CT scanner to look for bleeding in the brain -- one factor in whether they could safely use the “clot-busting” medication the ER has on hand. They alerted a neurologist and radiologist at the main campus to be ready to review the scan, which transmits instantly on the hospital’s digital system.

By then, the last scenario was about to start: a 54-year-old man, short of breath and with high blood pressure. Staff didn’t know it yet, but in a few minutes he would go into ventricular fibrillation and they’d be breaking out the paddles to shock his heart back into rhythm.

Colgate gave the teams an assessment of “good” for the morning’s trials.

“I think it’s especially good that we’re doing the scenarios, because we haven’t come across a big issue or deficiency, but we have come across a lot of little things. And doing this right is about the little things as well as the big things.”

In the afternoon, they ran through the stroke and heart attacks a second time. And 6:50 a.m. Tuesday, the first case arrived, a child with abdominal pain. The North Port emergency room was in business, 10 minutes before its scheduled opening.





	In North Port, practicing emergencies A medical team at Sarasota Memorial's new North Port emergency room performs CPR and intubates a robotic pediatric simulator in a scenario of a child that nearly drowns in a bathtub. The ER staff went through a series of tests Monday to prepare for Tuesday's opening. David Gulliver - posted 5:30 p.m. Tuesday, Sept. 1 Sarasota Memorial Hospital’s new North Port emergency room handled two births, a nearly drowned baby, a patient with a stroke and another with a heart attack -- all before lunch Monday. And that was a day before it opened. The flurry of cases was a series of elaborate simulations, designed by the ER leaders to test the staff’s skills, the equipment’s readiness, even the stocking of supplies before patients begin rolling in today. Staff knew the general nature of the cases, but none of the details and complications. It started at 10:08 am, with Maribeth Desiongco in a wheelchair, hysterical and hollering, eight months pregnant and about to deliver. “Is this your first baby?” a nurse asked. “No, it’s the second one,” she screamed. “I should have stopped at one, it hurts so bad!” Desiongco, a nurse, clinical educator and real-life mother of three, saw her role end at the door of treatment room 17, where a robotic medical mannequin lay on a bed, its belly swollen, a baby crowning. As seven nurses, technicians and a respiratory therapist crowd in, Suzanne Casey, a 16-year veteran of the main hospital’s labor and delivery unit, started dishing out pointers. “A lot of times the patient gets a little combative. There’s so much anxiety,” she said. They ask if the patient has any pre-existing conditions, any obstetrical problems. Casey reviewed the instruments and trays. Annette Freidhof, a nurse who has managed the main hospital’s ER and now will work in North Port, coaches their patient. “You’re going to be feeling a lot of pressure... you’re going to be pushing through this,” she said. In 19 years of the emergency room’s night shift, she said later, she saw just one delivery. Then the baby arrives, in somewhat of a tangle. “What we want to do is gently stretch the cord over the baby’s head,” instructs Debbie Dietz, a labor and delivery nurse for 18 years. And then they have him. “The best place for the baby is up here on the mother’s chest,” Dietz tells them. “You wouldn’t believe how quickly they pink up on the mom,” Casey says. They move the baby to a portable warming unit. It’s 10:22 a.m., and Dietz and Casey run through the post-delivery concerns and field questions for another half-hour. The ER looks much the same as that of the main campus. Its 21 observation rooms include some specially outfitted for trauma, labor and delivery, ear, nose and throat problems and mental illness. It cost some $20 million to build, and like many ERs will lose money -- an estimated $4 million in its first year. Emergency rooms have enormous staffing costs -- being open 24 hours a day and prepared for anything -- and are the primary source of care for the uninsured and poor who cannot pay their bills. (While Sarasota Memorial's overall bad debt fell about 7 percent from 2008 to 2009, the ER's share rose about 5 percent in that time.) But an ER can earn back much or all of those costs if it generates enough admissions to the main hospital. It is modeled on a similar facility in Ocala that broke even in five years. Another part of the building includes highly profitable MRI and CT scanners, and officials were surprised to have eight appointments already booked before opening. But even if the ER never turns profitable, Gwen MacKenzie, the hospital system’s chief executive officer, said building it was the right thing to do. “We have a responsibility to that community. There are 50,000 people who live there, and our commitment is to provide the care that is necessary,” she said. North Port residents have wanted their own hospital for three decades, even delivering some 22,600 letters to Tallahassee in 2003 supporting their drive. The next year, they seemed to have fulfilled their goal when state health planners gave their required approval to one of two competing proposals. But other hospitals appealed the ruling, and a judge reversed the approval. No one has tried to build a hospital in North Port since then. The ER is no full-fledged hospital, but hospital system officials have described it as a building block. If hospitals again compete to build there, Sarasota Memorial’s existing presence should give it an edge over other applicants, MacKenzie said. For now, the facility is capable of handling almost anything on its own, as staff soon learned. At 11 a.m, another staffer dashed in, shrieking that she only turned her back on her baby for a minute. He somehow slipped from a bathtub seat and now is not breathing. He has been down for about four minutes. In the treatment room, Dr. Bill Colgate, the hospital system’s director of emergency medicine, is on hand with another team of nurses and technicians. On the bed is the hospital’s pediatric simulator, a baby-sized version of the robot down the hall. They quickly assess the situation: no breathing, no pulse. They start CPR and administer oxygen and place an IV for medication. Then comes the morning’s only glitch. The crash cart has no pediatric respiratory equipment. A technician scrambles and finds it, and the team inserts a breathing tube. They find out later that one crash cart had been fully stocked, while theirs was not yet finished. With the medicine given and breathing tube in place, the baby’s pulse and respiration return. They call for a chest x-ray and bring the baby’s temperature up with warm blankets, and then call for helicopter transport to All Childen’s Medical Center. Meanwhile, Desiongco was again hollering down the hall as the second ER team started its delivery simulation. And minutes later, the first team went back to work as Keri Hockett, the system’s director of education and research, came in with clinical educator and “husband” Ron Bass. Colgate and team quickly diagnosed the unresponsive Hockett with a stroke, and wheeled her to the CT scanner to look for bleeding in the brain -- one factor in whether they could safely use the “clot-busting” medication the ER has on hand. They alerted a neurologist and radiologist at the main campus to be ready to review the scan, which transmits instantly on the hospital’s digital system. By then, the last scenario was about to start: a 54-year-old man, short of breath and with high blood pressure. Staff didn’t know it yet, but in a few minutes he would go into ventricular fibrillation and they’d be breaking out the paddles to shock his heart back into rhythm. Colgate gave the teams an assessment of “good” for the morning’s trials. “I think it’s especially good that we’re doing the scenarios, because we haven’t come across a big issue or deficiency, but we have come across a lot of little things. And doing this right is about the little things as well as the big things.” In the afternoon, they ran through the stroke and heart attacks a second time. And 6:50 a.m. Tuesday, the first case arrived, a child with abdominal pain. The North Port emergency room was in business, 10 minutes before its scheduled opening.