Scott Webb (Host): The Elliot Hospital Emergency Department is the busiest in New Hampshire, and that's just one of the reasons why it's been modernized and expanded recently. Joining me today to tell us more about the exciting enhancements to the Elliot Hospital ED is Dr. Matthew
Dayno. He's the Medical Director of Emergency Medicine at Elliot Hospital.

Host: This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about emergency care at Elliott Hospital and talk about the emergency department, how it came to be, what's involved, what folks can expect, all that good stuff. So, give us a little background on the Elliott Hospital Emergency Department.

Dr. Matthew Dayno: Elliot Hospital is a large community hospital in Manchester, New Hampshire and serves a pretty large central population area in Southern New Hampshire. The emergency department itself sees about 55,000 or so patients annually. We're a certified ACS level 2 trauma center, so we're a designated trauma center for the southern tier of New Hampshire. We also have an embedded pediatric emergency department within the general adult ED. And that sees 13,000 or so pediatric visits annually also. It's a very skilled team that works together, has become a very large department, and serves a pretty large catchment area for the most population-dense area in Southern New Hampshire.

Host: That's great to hear about pediatrics. I have two kids myself who were active in a lot of sports. And so, I've spent a lot of time in the emergency department at our local hospital, and so I know how important it is, you know, as a parent to have doctors and nurses there who are trained and used to working with children. So, that's awesome to hear. I know it's obviously a very busy emergency department, so maybe you can give folks a little understanding or idea of what they can expect in terms of the care they'll receive once they're there. 

Dr. Matthew Dayno: So, we're very excited because for the last four years or so, we have been planning, designing, and executing on a major expansion project in our emergency department to double our square footage and increase capacity, as well as really move the facility to a current modern facility that enjoys more privacy and some other major technology advances from our existing floor plan. And so, that's a really big piece of what we're excited about now in terms of what we're doing. Essentially the facility and the upgrade is supporting-- really, I'm biased-- but the most talented team in New Hampshire in terms of a really skilled large group of emergency medicine board-certified physicians. And we also have five pediatric emergency medicine specialists in our group. And this talented group of 26 physicians and 24 nurse practitioners and PAs care for that volume of patients that we see in the emergency department. And I think we're approaching close to
140 professional staff that includes RNs, paramedics, ER techs, unit secretaries, and additional ancillary staff that help serve a very busy, sort of urban-suburban emergency department that receives patients from Manchester, but also from a lot of surrounding areas. We also end up being a transfer center for smaller hospitals that transfer more complex cases to us. 

The other piece for patients in terms of what to anticipate is, when they come in, they're going to see a really dedicated, really advanced team of nurses and providers and all the other ancillary services that care for patients with very complex medical issues or an acute trauma or medical emergency as well as skilled in terms of helping patients that are suffering from maybe an acute issue related to a chronic medical diagnosis, you know, like diabetes, asthma, COPD, et cetera. 

Host: Yeah. You know, doctor, I think we've all been here before where we were trying to decide, you know, "All right, should I go to the emergency department? Should I go to urgent care? Can this wait until I see my PCP?" Maybe you can give us some expert advice here on when patients are trying to decide, you know, which level of care or how immediate the care should be, what kind of process should they go through?

Dr. Matthew Dayno: Yeah. That can be a difficult question to answer based upon, you know, existing medical conditions, your age, medications you may be on. But what we have done is we designed a really nice system where our board-certified emergency physicians work both in our emergency department as well as we staff three urgent cares that are connected to our health system and embedded into the Elliot system and the medical record itself. So, there's a lot of continuity in care and the same skill of those team members in the emergency department also work at our urgent care, which is a little bit different than some of the other urgent cares in the area. 

But in terms of triaging, any life-threatening emergency in terms of difficulty breathing, chest pain, acute severe allergic reaction, things that you think, you know, you would hang up and call 911 for, really we want to see you in the emergency department. Urgent care really is for an acute issue that typically you may think of as something that you could try to address with your primary care physician that maybe after hours or you're having difficulty accessing in terms of an appointment. Because our system with our physicians who are skilled in emergencies, we can care for
sort of that lower-level acuity stuff that people may historically think that they can get care for in the emergency department in regards to complex lacerations, small fractures and other injuries that you know tend to happen sort of when people are being active outside, as well as your sort of common illness complaints in terms of concern around strep throat, a respiratory illness, those types of things. 

In terms of triage, if you're having an emergency where you feel like you may or may not need the ambulance, that's where you're really triaging yourself right to the emergency department. If you're thinking about, you know, calling your primary care physician, that's usually a good first step. And then, if they're having difficulty accessing an appointment for you, then that's where urgent care, especially after hours, stands sort of at the ready to help people.

Host: Yeah. And it's good to understand the sort of tiers of care and, as you say, some of these things happen after hours. Okay, so maybe this is more of a PCP thing, but it's after hours, so we have urgent care. Maybe, you know, it does not quite rise to the level of ED. So, yeah, good to sort of understand a little bit maybe the thought process that we can all go through. 

And you talked a little bit about the expansion and renovation. Just maybe talk a little bit more about sort of the physical plan, like what it really means in terms of the size, the footprint, the technology
and so on. 

Dr. Matthew Dayno: Being the busiest emergency department in the State of New Hampshire continuing to grow in terms of the volume of patients that we're seeing and needing to handle and operating in a physical plan or floor plan that was really developed in the early to mid-'90s, where the care and the types of patients, the acuity of illness and the volume of patients that we're seeing was very different. 

And so, the big change is that we designed a floor plan that creates a lot more space in regards to hallways and movement of patients, as well as to try to create a floor plan that is designed around efficiency. So, we designed what's called a hub and spoke model where the nurses and the physician team, the care team is really sort of in the central and can very quickly get to each patient exam room. 

The other thing that was a major change is all the exam rooms are private, closed doored areas. So, that prevents concern around spread of infectious disease as well as increases the privacy capacity, for that encounter for the patient and their experience. 

The other major things around the design that we did were this part of this process in design occurred during the early pandemic days, and we realized it was really important to be able to cohort infectious and non-infectious patients in terms of respiratory or airborne illness. And so, we created the capacity to section off certain areas of the emergency department, with different airflow, so that you could try to keep those patients that maybe infectious with concern around whether it's influenza or COVID, separate from those patients that are there for, you know, say abdominal pain or
traumatic motorcycle injury.

Host: Yeah. In fact, I was going to ask you, you know, how much or did COVID-19 did the pandemic influence the design of the new ED? But it sounds like it really did and really responding to the needs, not only during this pandemic, but perhaps, unfortunately, you know, if we get there, future pandemics. Maybe you can talk a little bit more about that, about how the pandemic really influenced the renovation and expansion. 

Dr. Matthew Dayno: Yeah. So, two big ideas around that. One is that you really saw that you needed to be able to separate patients by potential concern around their infectious complaint, meaning that if you had patients that had respiratory illness and you're trying to keep them away, for example, like a cancer patient, they're immunosuppressed, and they're getting chemotherapy. It’s really important to keep those patient populations separate and so, to be able to what's called use negative pressure, airborne isolation, so to keep those cohorts of patients separate. So, that was a big information gather that we had from the pandemic in the early design period. 

And the other thing that we learned too is that standardizing the way rooms are designed, specifically in terms of patient exam rooms and supplies so that you're improving efficiency so that once, say, you're going in to treat an infectious patient, you're not having to go in and out of the room
multiple times. So, we create a cart system designed around really minimizing waste in terms of movement, accessory movement, and keeping the care team right at the bedside with the patient. 

Host: That's awesome, doctor. You know, it sounds like just this amazing, you know, large multidisciplinary team and really responding to the needs of the communities that you serve, responding to the pandemic and all of that. And, you know, doctor, I would love to believe that folks always listen to the entire podcast. But you know, we sort of live in a world of headlines and social media. So here at the end, I just want to give you an opportunity, you know, if you were going to put a headline on this when we talk about the sort of new and improved ED at Elliot Hospital, in your words, what would you say? 

Dr. Matthew Dayno: Yeah. I would say that the same really talented, bright, amazing team that stands at the ready to care for a person and their family in an acute emergency is still the same team. What we did was really upgrade the space and the technology and the resources for that team to be able to better prepare and care for those patients and their family members. It's typically when you're presenting to the emergency department, we're used to it. We're used to being on the other side and taking care of some, you know, very seriously injured and/or sick patients. But for that
person experiencing that emergency that day, typically, very uncomfortable, maybe the scariest day of their life. And so, you really want the team that's around them to care for them to be best prepared and best resourced. And so, this really the same amazing team, but allowing them to really provide care for the patients that we want to do. 

Host: So, yeah. Well, that's perfect. I appreciate your time today. Always great to learn and hear from, you know, hospitals and doctors and nurses of course and members of the team that places like Elliot Hospital are investing and reinvesting and try to give you the space and the tools and the technology. As you say, you know, you're all there waiting for us to show up. You know, you're just doing what you always do. But now, you're doing it in this sort of new and improved and renovated and expanded space. So, it sounds awesome. Thanks so much, and you stay well. 

Dr. Matthew Dayno: Thank you. Appreciate it. 

Host: And for more information, visit elliothospital.org/website/emergency-medicine.php. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New
Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and
we'll talk again next time.