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LAC+USC Medical Center

Department of Emergency Medicine

LAC+USC Medical Center

The patients served at the LAC+USC Medical Center come from a varied ethnic background with a significant Latino population, a substantial working class population and a large number of indigent patients. Since the County Hospital is tasked with providing care for all those who cannot afford it elsewhere, the mean socioeconomic level tends to be low with the attendant problems of chronic poor health maintenance, variable compliance, and lack of support systems. Superimposed on this demography is a high incidence of gang- and drug-related violence and vehicular injury, which leads to a large volume of both penetrating and blunt major and minor trauma.

The Department of Emergency Medicine (DEM) is an autonomous clinical and academic department within the Medical Center and Medical School. It has the responsibility for initial triage, evaluation, management, and disposition of up to 500 patients daily, including pediatric trauma as well as those who present with the complete spectrum of adult medical and surgical problems. Non-emergent OB/GYN patients, pediatric non-trauma patients, and medically uncomplicated psychiatric patients are seen in the Emergency areas of the Women’s and Children’s Hospital (WCH) and the Psychiatric Evaluation area located in General Hospital. Emergency Medicine residents rotate in the Pediatric and GYN Emergency areas at WCH and may selectively rotate in the Psychiatric Evaluation Area as part of their training. The Department of Emergency Medicine is also responsible for an active Paramedic Base Station, the Hyperbaric Treatment Chamber on Catalina Island, the Center for Life Support Training and Research, the Emergency Evaluation Area of the Los Angeles County Jail Service, a six bed Chest Pain Unit, and an 11 bed Observation Unit.

The Emergency Department is organized into multiple clinical areas:

• Emergency Department – (1350) sees all critical and non-ambulatory sick and injured. Such patients include victims of stroke, cardiac disease, and acute intoxications, as well as all the major adult and pediatric trauma victims presenting to the medical center.
• Emergency Department – (1050/1060) sees all eye and ENT problems, non-critical bone and soft tissue injuries and infections. Stable non-traumatic ambulatory patients are also assessed in this area. Until March of 2006, the DEM maintained a “Fast-Track” follow up clinic where emergent patients were reevaluated within the first 24 to 72 hours.
• Emergency Department – The Jail ED sees all persons in custody requiring medical attention. Currently, the area is staffed using as-needed physicians.
• Chest Pain Unit/ 1201 – The CPU sees and treats 5 to 6 patients a day who have presented with low risk chest pain. Here, patients are ruled out for acute coronary syndrome, and undergo a process of risk stratification (e.g. exercise treadmill test, nuclear imaging).
• Urgent Access Diagnostic Center (UADC) – The UADC, created in March 2006, provides urgent, scheduled access for low-acuity patients who present to the LAC+USC Emergency Department. The UADC facilitates rapid outpatient diagnostic options for patients who need timely evaluation.
• Observation Area – The Observation area was established in September 2006 with the goals of providing a location for patients who require continued observation and short-term therapy for an emergent condition or those awaiting definitive diagnostic testing. The 9-bed Observation Unit is protocol-driven, staffed by DEM midlevel practitioners 24 hours/7 days a week, and is supervised by DEM Attendings. Patients are observed for up to 24 hours, at which time they are either discharged home or admitted to an impatient bed. Since its inception, the Observation Unit has cared for an average of 150 patients/month with a 33% subsequent admission rate. By moving these patients out of the Emergency Department and to the Observation Unit, we offer a more suitable setting for continued observation, open much-needed bed space in the ED, as well as avoid admission of patients that are unlikely to stay for more than 24 hours.