Executive Summary

The University of Michigan Health System (UMHS) in Ann Arbor has opened a new unit within its ED to focus on caring for the most critically ill patients who present to the ED. Dubbed the Massey Emergency Critical Care Center, or EC3, the model is the first of its kind in the country, with its own ICU and a lower nurse-patient ratio than the main ED to facilitate closer monitoring. Developers hope the new unit will decompress the ED, shorten wait times, and potentially reduce the demand for ICU care on the upper floors.

• The adult ED at UMHS receives patients on the higher end of the acuity spectrum, with high-acuity patients making up 90% of the patient volume.

• Staffing of the EC3 includes emergency nurses and physicians who have had extra training in critical care.

• The EC3 will serve as a new research center for emergency critical care patients, and a training ground for physicians and nurses looking to enhance their skills in critical care.

While the Massey Emergency Critical Care Center (EC3) at the University of Michigan Health System (UMHS) in Ann Arbor has only just opened its doors, planning for the unit has been a multi-year, multidisciplinary effort, explains Jennifer Gegenheimer-Holmes, RN, BSN, MHSA, CEN, the director of operations for the Department of Emergency Medicine at UMHS. “We created an emergency critical care advisory group [which includes] the medical directors of the adult ICUs here, respiratory therapy, and our physician leads within the ED,” she says.

The emergency care leaders in the group made it clear that they wanted to partner with the critical care specialists to develop a unit that would offer benefits and solutions to both sides. “We are all trying to manage our scarce resources in different ways, and this really has been a team effort all the way around,” observes Gegenheimer-Holmes.

This advisory group has been focused on reviewing all of the hospital’s critical care admissions to identify the types of patients who would benefit from early interventions and a consistent protocol that may start as early as when patients are en route to the hospital in an ambulance, but certainly when they arrive in the ED, observes Gegenheimer-Holmes.

Further, now that the EC3 is open, Gegenheimer-Holmes is working with the other group members to bring more consistency to the way critical care is delivered hospital-wide, so that the same equipment and processes are used in all the ICUs as well as the EC3.

While the new unit is designed to improve care and outcomes for emergency critical care patients, it has also been designed with research in mind. Developers are hoping that the first-of-its-kind center will attract research dollars and facilitate the testing of new treatments, diagnostic tools, and devices. In fact, research is already underway on sepsis.

“We built a database for sepsis a year ago so that we could track the before and after, and how the EC3 is impacting care,” offers Gegenheimer-Holmes. “We are really trying to look at this as an ecosystem — and how this change in the ecosystem is affecting critical care throughout the hospital.”

Additionally, developers note that the EC3 will serve as a fertile training ground both for nurses looking to specialize in emergency critical care and emergency physicians who are seeking to enhance their skills with board certification in critical care.

“We are the only place in the country that has an ICU like this in the ED, so emergency physician fellows are coming now, and they are learning as we learn now too how to manage these patients,” explains Gunnerson.

What is different about many of these patients who present to the EC3 with critical care needs is that they are what Gunnerson calls undifferentiated: no other physician has touched them before. “A lot of times when patients come to the ICU, they are coming from the floor or from the ED and several [clinicians] who have seen them have already weighed in on what’s going on,” he says. “Here [physicians] get to start from scratch, so this is going to be part of their training: how we work these patients up, and how we take it from there to that next level.”