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October 22, 2001

New first response center PACEs Grady ER care

By Alicia Sands Lurry


Visiting an emergency room in the event of a serious accident, toothache or some other nagging pain can be a trying experience for almost anyone, and waiting endless hours to be seen by a physician for a minor injury can be just as upsetting. Most people want their aches and pains addressed right away—without waiting and wasting time.

At Grady Hospital, such concerns are being addressed, thanks to PACE (Patient Ambulatory Care Express), a 24-hour “fast-track” emergency department of sorts, supervised by Emory physicians, that aims to treat minor pains and injuries in a fraction of the normal time. In fact, more than 25 percent of all patients seen in Grady’s Emergency Care Center are seen in the PACE area.

“The thing patients care more about is getting seen as quickly as possible,” said Richard Ismach, PACE medical director and assistant professor of emergency medicine in the School of Medicine. “People are seen and treated much more quickly than they
would be if they were going through a regular emergency

Leon Haley is medical director of the Emergency Care Center, chief of service for emergency medicine and assistant professor of emergency medicine. He estimated that the average time from entry to discharge for patients entering PACE is usually three hours, noting that the wait time to be seen is actually very short.

After entering triage and registration, patients in the PACE area typically are treated by a separate staff of physicians, nurses, physician assistants and nurse practitioners. Having a separate staff, Ismach said, allows center patients to be seen in a timely, efficient manner.

And while studies suggest a substantial minority of emergency department patients have “non-urgent” problems, physicians cannot simply turn them away, said Arthur Kellermann, professor and chair of emergency medicine.

This is because federal law requires emergency departments to conduct a “medical screening exam” on every patient to determine that an emergency condition does not exist—something that cannot be safely or legally done at the triage desk.

Another reason, Kellermann said, is that approximately
5 percent of patients thought to be non-urgent over the phone or at triage actually turn out to have a serious problem that requires immediate hospitalization.

“Fortunately, PACE is backed up by the full resources and expertise of the Grady Emergency Care Center, which is staffed by emergency medicine specialists 24 hours a day, seven days a week,” Keller-mann said. “This way, patients get cost-effective care, referral to a primary care physician or clinic for follow up, and the safety net of the Grady ECC if their ‘heartburn’ turns out to be a heart attack.”

According to Ismach, fast-track medicine has become a fairly popular idea in urban hospital emergency departments over the past decade. He said what makes PACE so effective is that it is part of Emory’s emergency medicine department, which has well-trained physicians.

“Our physicians are more intimate with state-of-the-art emergency medicine, and we are providing high quality, world-class care,” Ismach said.

Ismach hopes PACE will soon begin attracting even more patients—namely business professionals in downtown Atlanta who, if injured, will come to PACE for prompt,
efficient medical care.


Back to Emory Report October 22, 2001