Billings Clinic has a standing commitment to serving our region with the best care available. Our Emergency and Trauma Center has a Level II designation and is the only accredited Chest Pain Center in Montana. With the increased demand for health care services in Montana, Wyoming and the western Dakotas, our Emergency & Trauma Center, completed in March 2007, will meet the needs of the future. The Emergency & Trauma Center provides state-of-the-art technology and evidence-based design that gives our physicians, nurses and care givers the opportunity to provide proven best care practices.
With Billings Clinic’s electronic medical record, our Emergency and Trauma Center physicians and nurses have advanced communication links to our regional clinics and to many emergency departments in our region, and they are supported by outstanding critical care fixed wing transport by Billings Clinic MedFlight.
Regional Emergency Services Combines Care and Leading Edge Technology
MedFlight provides emergency and critical care air transportation for seriously ill or injured patients of all ages. Billings Clinic’s board certified physicians work as a team to care for the transported patients. Other regional services offered include:
- Teleconference education
- Tele-radiology for interpretation of radiology studies
- EKG interpretation and treatment prescribed while the ambulance is en route, enabling faster treatment of heart attack patients
Mobile Technology at the Bedside
Because Billings Clinic’s specialists work together and are integrated with coordinated clinic, hospital and lab services, a patient’s electronic medical record is instantly accessible at all Billings Clinic locations. While the emergency department has been using Billings Clinic’s electronic medical record since July 2004, the new Emergency and Trauma Center integrates mobile information systems technology into the workflow.
In the Center, physicians have bedside wireless tablets used at the point of care to access the patient’s medical history, including medication information, allergy information, lab and test results, physician notes and more. “From the patient safety standpoint, having both the hospital and physician notes is important,” Billings Clinic Emergency Physician Ronald Winters, MD, said. “With the electronic medical record, we can see what’s been done and can access that information while speaking to the patient. For medication safety that’s really invaluable in patient care. We can also order treatment while in the room with the patient. That cuts down the wait time, which sometimes is critical for the patient’s care,” he added.
In addition to communicating with the patient, wireless telephone technology speeds up communication between physicians, allowing an emergency physician to speak directly with another specialist, such as a cardiologist, while remaining completely ¬mobile.
The decentralized nursing stations in the new Center require mobility of information technology. Computers On Wheels (COWs) provide flexibility of moving from room to room.
The expanded use of electronic tracking boards in the new Center enhances patient care. These boards indicate where a patient is in the care continuum. In addition to the emergency department, tracking boards are located in key departments involved in the patient’s care, such as the radiology and pharmacy departments.
“Some departments are physically remote from our department, but are very involved in what we’re doing in our department,” Dr. Winters said. The tracking board ensures that physicians know where a patient is along the care plan.
Patient-Centered Design Focuses on Quality, Safety and Service
The Emergency & Trauma Center is designed to provide patients the best quality, safety and service available. The new design started by recognizing the best emergency care occurs when the nurses and doctors are close to their patients at all times. Using examples of evidence-based design from the nation’s leading health care institutions, our planning team decentralized the work areas to place emergency staff adjacent to the patient rooms where they provide care. This decentralized model aligns the patient with his or her care givers in a more focused, less congested, care environment. This will greatly benefit all patients and their families but especially our pediatric patients.
Medical technology is also closer to the bedside. The Emergency Department was the first Billings Clinic department to implement the full complement of computerized medical record, patient tracking and physician order entry. A doctor may visit with a patient at the bedside while accessing his or her complete Billings Clinic medical record. The Center houses a state-of-the-art CT scanner capable of imaging heart vessels, technology that will replace more invasive angiography used today. A patient with chest pain may soon be able to have coronary anatomy clearly imaged, a treatment plan developed and go home the same day.
The full breadth of Billings Clinic physician specialists is available to emergency and trauma patients.
- The MedFlight team is ready to stabilize and transport patients from around the region and the emergency, critical care and trauma staff respond as a stabilization team for all patients with known or potential serious illness. The Stabilization Room is a focal point in the new Center and exemplifies Billings Clinic’s commitment to quality care.
- As the only health care organization providing comprehensive inpatient psychiatric care in the region, the Center is designed to safely and discretely assess the needs of this important patient group. Our psychiatrists and specially trained social workers work hand in hand with emergency staff in a crisis intervention area of the department to help these patients and their families.
- The Center has increased the capability to care for women’s needs in a dedicated area as well as continuing the SANE (sexual assault nurse examiner) program. Privacy is always an important part of quality care and the decentralized design enhances patient safety and security.
- Specialized rooms for orthopedic, eye, and ear, nose and throat problems will streamline emergency visits.
New Center Features Nation's Best Design Concepts
In the process of planning the Emergency & Trauma Center, the organization looked at function and staff needs while drawing up the floor plan. As a result, it took several years of preparation and planning to study emergency department (ED) operations, staffing patterns and technologies. The ED began by analyzing current workflow processes and determining what processes needed to change to meet the future needs of the Emergency & Trauma Center.
Decentralized nursing, with patients being taken care of in a care team area by a physician, nurse and patient care technician, was one of the highlights of the needs assessment. “It’s all about the patient being assigned to the right care team area in triage, as well as the staff having everything at their fingertips to do their jobs efficiently and effectively in that care team station. Our patients and families will love it!” said Cheryl Christensen, RN, and department manager.
The physical plant was planned to improve ED workflow operations and enhance patient and staff safety and satisfaction. The ED provides quality care to its patients with nationally-recognized stroke and heart care. The Emergency & Trauma Center operational workflow redesigns enhance the patient’s safety and experience in the department.
Critical Care Rooms Incorporate Evidence-Based Design
Cardiac and stroke patients receiving emergency care at the Emergency & Trauma Center are treated in state-of-the-art rooms designed specifically for care to those patients who are critically ill or injured. The Center features eight critical care rooms, including two designated resuscitation suites, and six other rooms available for emergent situations such as cardiac arrest, stroke, major trauma and other acute injuries or illnesses.
The critical care rooms in the Emergency & Trauma Center were designed with input from emergency department staff, as well as staff from other care teams such as radiology, laboratory services, pharmacy and more. The rooms are standardized and larger. In fact, each room is designed identically, with all medical equipment located in the same place. “The ability to have the rooms identical, so that it is a simple reflex to grab the things we need is a big advantage,” said Robert Verndon, RN. “Having enough room for staff to be around the patient at the same time is also important.”
Essential medical equipment is organized on a boom system that hangs from the ceiling, moving equipment off of the floor and cords out of the way. Caregivers can then have 360-degree access to the patient. “This is evidence-based design and state-of-the-art,” Christensen said.
Enhanced technology includes a 64-slice CT scanner for diagnosing brain injury such as stroke in the emergency department. And the stroke medication, tPA, is available in the resuscitation rooms for the immediate treatment of stroke. Other features include bedside electrocardiograms (EKG), as well as the ability to receive pre-hospital EKGs sent from the field so cath lab staff can arrive at the Center before the ambulance arrives. Our team approach expedites patient care along with new communications systems that improve coordinated care between cardiology and emergency department physicians.
New CT Scanner Next to Patient Rooms
A 64-slice CT scanner is located within the Emergency & Trauma Center. This technology offers offer extraordinary CT imaging with detail and image quality unmatched by previous technology. Imagine scanning the human body in under 10 seconds, a valuable time savings to the trauma patient.
The use of such thin slices provides a volume of information to the physician and facilitates CT angiography as well as high resolution imaging in the body, head, spine and extremities. Even the smallest of structures is visible with this combination of thin slices and high resolution. Billings Clinic can now also take advantage of new techniques to reduce the amount of radiation a patient is exposed to. The newest application for this multi-detector CT system is cardiac imaging will allow for evaluation of the cardiac structures and vessels.
Upon arrival at the Center, families will find a large waiting area with a children’s lobby area adjacent, so parents can watch their children while they wait. The children’s area offers special toys that are easily disinfected, kid-sized furniture, a TV that plays only the Disney channel and a sand table that is like a giant Etch-A-Sketch.
The Emergency & Trauma Center is divided into four areas, with a care station and a team of care providers (physicians, nurses, technicians) in each area. All of the patient rooms are multi-functional but one area is dedicated to serving women and children. The pediatric rooms have special artwork, including ceiling tiles hand-painted by children from local elementary schools.
This care station is conveniently located close to the waiting area and is tailored to the needs of families. The area includes two special rooms for obstetrical or gynecological emergencies, including a private bathroom. More than 53 percent of emergency visits are female patients, and many women bring their children with them if child care isn’t available at home.
We are family friendly throughout the new Center, from the waiting rooms and restrooms to the treatment rooms. We have clouds on the ceiling of the CT scan room to help divert the kids’ attention when they need a scan. Most importantly, the larger rooms allow parents to stay with their children all the time.
Healing Environment Eases Stress in Emergency & Trauma Center
The nurses, physicians and staff of the emergency department know that stress-reduction and comfortable surroundings work to enhance emotional and physical healing.
From the design that incorporates curves rather than having sharp corners, to the soothing colors of nature and the quiet atmosphere of private rooms, with walls and doors instead of drapes. The colors of nature are taken from our region’s natural surroundings: the Rimrocks, mountains, flora and sky. Contemporary muted earth tones replace the sterile “vanilla” that so often defines clinical settings. The floors have curved inlays and are made of composite materials that replicate natural geological formations. The countertops are made of similar nature-inspired composite material. Everything has smooth corners that blend with the flowing curved design of the entire Center.
Nurse stations are designed for close proximity to monitor four-to-five patient rooms. The patients will never feel alone or unattended. Each patient room has a flat-screen television to act as a diversion while test results or other care needs are being handled.
The spacious, window-lined lobby welcomes patients and guests with the warm feeling of a Montana lodge. A sandstone fireplace with a natural wood mantel is surrounded by a comfortable, spacious seating area. A large screen television is available for guests. The dedicated children’s area features rocking chairs, kid-sized table and chairs, and a separate television with children’s programming. A barista-style coffee bar is available in a separate area where the new Center connects with the hospital.
The Deaconess Healing Garden near the entry of the Emergency & Trauma Center will provide a place of respite for visitors and patients who wish to stroll or relax in a park-like setting. Kiosks and a commemorative walkway honor the history of the Deaconess Hospital, Billings Clinic and historical milestones of the organization. A stream, rocks, native plants, natural grasses and trees that were carefully preserved during construction provide an outdoor healing environment for all to enjoy.
Sexual Assault Nurse Examiner (SANE) Services
Our sexual assault nurse examiner (SANE) room provides a safe place for people to come that’s private and appealing. Our specially trained SANE nurses care for sexual assault victims with dignity, help them plan their next steps, and collect evidence for law enforcement. The SANE room is a larger and more comforting environment, including a private bathroom and a shower. Learn more.
Post 9/11: New Center Ready for Emergencies and Disasters
Billings Clinic is prepared to respond to all foreseen emergent events and disasters in the region. As a member agency of the Yellowstone County Local Emergency Planning Committee (LEPC) Unified Health Command, Billings Clinic partners with many health care organizations in the county that share the same responsibilities.
Billings Clinic recognizes its role as a critical community resource in the time of emergencies and disasters, and maintains collaborative relationships with community partners to help ensure the most timely and effective response to emergent events.
Billings Clinic has been the recipient of several grants over the past five years targeting the purchase of equipment, training expenses and to develop and test scenario-specific response plans. One example includes hazardous material decontamination supplies, allowing the facility to decontaminate victims of virtually any hazardous material known to exist in or pass through the county. A recent addition is a trailer designed to allow Billings Clinic personnel to become portable with the decontamination process.
As part of the commitment to maintaining a well equipped facility, the new Emergency & Trauma Center includes numerous emergency response components:
- Traffic flow is expedited directly to health care operations.
- The large garage area allows for mass casualty triage and then direct transfer to appropriate treatment facilities.
- For events involving a hazardous substance, decontamination showers and equipment are located at the entrance of the Center to facilitate immediate decontamination while protecting the interior of the emergency operations from contamination.
- The fixed shower system can accommodate approximately 12 victims per hour.
- Additional mobile decontamination equipment allows for decontamination of approximately 90 victims per hour.
- Immediately adjacent to the decontamination area are treatment and triage rooms with unique air handling capabilities to allow for isolation to prevent contamination of the rest of the building.
- A common problem with hazardous materials events is the retention of waste water used to decontaminate victims. Built into the drain systems is the ability to capture the waste water into the 1,000 gallon reservoir located in the parking garage of the building.
- The new facility allows for more usable storage and deployment of disaster management supplies and equipment.
- In-house and external radio communication systems have been improved to ensure better communication during emergent events.
Billings Clinic is committed to its responsibilities to support the region in emergency response and its active participation in the LEPC and encourages all community members to learn more about what they can do to better prepare themselves and our community to respond to an emergent event.
MedFlight Provides Rapid Critical Care Transport of Patients in the Region
As a verified American College of Surgeons Level II Trauma Center and State of Montana designated Trauma Center, Billings Clinic strives to improve the quality of health care it brings to the community and surrounding region. Our Center’s physicians, nurses and patient care technicians are trained to provide, educate and promote up-to-date health care to meet the needs in our environment today.
The members of our community and region are better served in a center built to improve the overall care and experience of simple or complex health care needs in an emergency setting. Billings Clinic’s MedFlight air ambulance service optimizes our regional service providing safe and rapid critical care airplane transport to the Center. MedFlight’s team is comprised of critical care nurses and respiratory therapists who are trained to provide stabilization of all health care needs available at our facility. The most common reasons for transport were cardiac, medical and trauma.