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October 4 , 2001


Patient Ambulatory Care Express (PACE) at Grady Hospital "Fast Tracks" Treatment of Minor Injuries

Visiting an emergency department 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 without wasting excessive time.

At Grady Memorial Hospital, such concerns are being addressed, thanks to PACE, or Patient Ambulatory Care Express, a 24-hour "fast track" emergency department of sorts supervised by Emory University emergency department physicians. PACE aims to treat minor pains and injuries within 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 Dr. Richard Ismach, medical director of PACE, and assistant professor of emergency medicine in Emory University School of Medicine. "People are seen, and they're treated much more quickly than they would be if they were going through a regular emergency department."

Dr. Leon Haley is medical director of the Emergency Care Center, chief of service for emergency medicine, and assistant professor of emergency medicine in Emory School of Medicine. He estimates 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 are typically treated by a separate staff of physicians, nurses, physician assistants and nurse practitioners. Having a separate staff, says Dr. Ismach, allows patients to be seen in a timely, efficient manner.

And while studies suggest that a substantial minority of emergency department patients have "non-urgent" problems, physicians cannot simply turn them away, said Dr. Arthur Kellermann, professor of emergency medicine and chairman of the Emergency Medicine Department in Emory School of 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, according to Dr. Kellermann, is that approximately five 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," Dr. Kellermann 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 Dr. Ismach, fast track medicine became 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," Dr. Ismach said."

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


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