It is a parent’s worst nightmare. A car crash on a coastal Oregon road results in life-threatening injuries to their toddler. An ambulance takes the child to the nearest emergency department at Columbia Memorial Hospital in Astoria, where the emergency medicine-trained physician immediately calls a colleague at OHSU Doernbecher Children’s Hospital. She will be flown to Portland, but in the meantime, the physician at Columbia Memorial Hospital knows exactly what to do.
Two weeks later, the parents send a photo of their smiling child to the emergency department staff in Astoria. The child is recovering well, thanks to a strong collaboration between the two facilities and board-certified emergency physicians delivering care at a critical moment.
This fictionalized scenario is entirely plausible and speaks to the model of emergency department staffing that has been in place since 2015 in Astoria’s Level IV Trauma Center and critical access hospital. The five emergency medicine-trained physicians there are OHSU faculty members who, together with their interprofessional health care teams, manage about 13,000 emergencies a year.
A model for exceptional emergency care across the state
The story behind how these physicians got to Columbia Memorial Hospital started with a problem – a good problem – faced by John Ma, M.D., F.A.C.E.P., professor and chair of emergency medicine in the OHSU School of Medicine. He receives up to 40 unsolicited resumes each year from highly qualified clinicians in the field of emergency medicine. They want to work for OHSU and serve its missions of teaching, healing and discovery.
Thanks to OHSU health system’s long-standing strategy of collaboration with hospitals like Columbia Memorial and affiliations with Tuality Healthcare and Adventist Health Portland, Ma has options for these potential recruits.
Clinicians joining the OHSU health system today could be stationed anywhere from The Dalles to Portland to Astoria, and emergency medicine is a prime example of the growing OHSU campus. Faculty members and clinical associates – a group of OHSU Practice Plan providers who focus exclusively on patient care – are now staffing a system of emergency departments in Astoria, Hillsboro, Portland, and, coming later in 2019, East Portland at Adventist Health.
“My number one goal is to deliver the highest quality and safest possible care to all Oregonians,” said Ma. “People walking into any of the emergency departments we staff should have the same outstanding service and quality of care. We are making that a reality through our regional partnerships.”
Back in spring 2015, Erik Thorsen, M.B.A., chief executive officer at Columbia Memorial Hospital, had a vision for the seaside community hospital. He wanted their emergency department to be the first on the Oregon Coast staffed with board-certified, residency-trained emergency medicine physicians.
Thorsen had already established collaborations with OHSU in areas like ophthalmology, radiation therapy, cardiology and a telemedicine program for stroke and pediatric specialty services in the emergency department. A series of meetings between Ma and Mark O’Hollaren, M.D., M.B.A., OHSU vice president for strategic outreach, sealed the deal. OHSU began recruiting physicians for the emergency department in Astoria.
Anthony Ferroggiaro, M.D., assistant professor and vice chair of emergency medicine in the OHSU School of Medicine, was one of the first to come aboard. He joined in 2015 as medical director of emergency medicine for Columbia Memorial Hospital. He said strong leadership coupled with an excellent nursing staff, radiology and lab teams has resulted in a successful collaboration between the community hospital and its metro-area academic counterpart. Hiring physicians with an “autonomous streak,” as Ferroggiaro put it, did not hurt, either.
“The doctors in the Astoria emergency department are special people. They are able to function in a situation where they have absolutely no backup; they are a trauma team of one. We manage all the critical care, the airways, the lines, and the major intensive care unit patients,” he said.
The collaboration extends to graduate medical education training and is an important workforce pipeline for rural Oregon. Emergency medicine residents began rotating in Astoria in 2016. Their first – Shannon Berry, M.D. R’17 – is now on the Columbia Memorial Hospital staff and an assistant professor of emergency medicine at OHSU.
An accident similar to the one described above occurred about six months after the partnership began, and “it was a turning point,” said Ferroggiaro. “The Astoria community saw what a difference they had in the emergency department physicians out there, and the care teams saw the potential for teamwork to align in optimal patient care and service to their community.”
Partnership in Hillsboro with Tuality emergency department came next
Fast forward to July 2018. The OHSU Department of Emergency Medicine begins staffing the Tuality Community Hospital emergency department. A bustling ED that brings in about 88 patients a day to its 16 beds, the Hillsboro facility sees 37,000 visits a year.
Meaghan Dehning, M.D., vice chair and medical director for the Tuality Healthcare emergency department, said because of its more rural environment, emergency room patients in Hillsboro bring a unique challenge for her and colleagues. They see logging injuries, recreational accidents, and more immigrant workers and nursing home patients compared to a Level 1 Trauma Center like OHSU Hospital.
“Tuality nurses and staff have a lot to bring to the table. They have a 100-year history of serving the community and that really infuses their philosophy and allows people like me from a specialty academic center to learn from them,” said Dehning, who is also assistant professor of emergency medicine in the OHSU School of Medicine.
The department hired 10 physicians and 2.5 FTE advanced practice providers to staff the Tuality ED. Department Administrator Mirjana Kasap-Trifunovic and Associate Department Administrator Stefanie Roland are the organizational muscle behind this staffing model, coordinating everything from recruitment and interviews to financial planning.
Keeping patients in their community has been a primary goal since the partnership between OHSU and Tuality Healthcare began several years ago. With the ED staffed and the ability for clinicians to consult electronically between Portland and Hillsboro, patients and families can stay close to home for lifesaving care.
The OHSU Department of Emergency Medicine is still expanding. Plans are underway to hire 13 physicians and six advanced practice providers for the Adventist Health Portland emergency department, which gets about 50,000 visits a year. Ferroggiaro will assume the medical director role there, while Regina Mysliwiec, M.D., assistant professor and vice chair of emergency medicine in the OHSU School of Medicine, is taking over as medical director of emergency medicine in Astoria.
When the Adventist ED transitions to OHSU staffing by July 1, Oregonians who need emergency care will get it from OHSU clinicians in five emergency rooms across the state:
- Adventist Health Portland
- Columbia Memorial Hospital
- Doernbecher Children’s Hospital
- OHSU Hospital
- Tuality Community Hospital