UPMC Mercy has the busiest emergency department in the city of Pittsburgh, with a high percentage of our inpatient volume coming through that access point. The Department of Emergency Medicine team has the expertise to care for patients needing Level 1 trauma, burn, comprehensive stroke, orthopedic, medical, and surgical services, and more. As a strong interdisciplinary team, the ED has persevered through the past three years, a truly challenging time in healthcare.

This team was not immune to the challenges of “The Great Resignation” that occurred during the pandemic. They lost a significant number of staff, having to rely on an agency to assist. This was difficult as the team needed strong practitioners to care for the significant trauma volume that comes to Mercy, but this did not stop them from being creative and innovative! They partnered with the TBU to accommodate the lack of trauma expertise from agency nurses and had the TBU staff rotate into the ED to assist in caring for the trauma and burn patients. This model has led to a trauma response team and a dual-unit model for nurses!

The culture of the UPMC Mercy emergency department is supportive, cultivating an environment that attracts new team members. For example, as the ED team welcomed the travelers as part of the team, building their competencies along the way, many saw the rich and supportive culture and decided to join the team! A good number of travelers stayed and are now members of the team. The ED continues to recruit and retain team members through accountability, support, and shared decision-making. At this time, their nursing positions are filled, and as positions become available, they can now be filled with nurses with foundational acute care experience to assist them in this transition. The team takes pride in making their environment and their unit better. This interdisciplinary ownership is evident and palpable.

Boarders are a reality in healthcare across the country. Because of the high number of UPMC Mercy patients who enter through the ED, this was a significant issue that needed to be considered in day-to-day care. The Director, Val Schreiber, and the Medical Director, Dr. Mike Turturro, partnered with hospital leadership to improve throughput and flow. All UPMC leaders owned and were responsible for our boarders, working to ensure they received excellent care. ED-specific tactics included the vertical treatment zone, pull till full, hallway beds, 10-10-send, and physicians in triage. More discharge plan managers were assigned to the ED to also assist in timely care delivery and discharge, and resources from the resource pool were allocated to the ED daily as needed. This ED team played an active role in implementing the discharge/transitional care unit. While inpatient nurses worked to recruit and retain nurses to increase unit census, the leadership stayed focused on the ED to assist in ensuring resources were available to assist. While we still have work to do to support patient flow and capacity, the ED team continued to explore strategies that mobilize patient throughput while continuing to focus on excellence in practice.

The new Mercy Pavilion brought new ophthalmology volume, and the ED team worked swiftly to build staff skills and competency in caring for this new patient population and even added a new dedicated space for delicate eye examinations. They support each other through a myriad of difficult situations, including the death of a team member, a significant increase in patient trauma, and an increased frequency of workplace violence. The ED team always comes together and perseveres. They are amazing and deserve high praise and appreciation. UPMC Mercy is better for having such a strong, dedicated team of professionals.

Most recently, a summary of the extraordinary care provided by this team was explained by an AOD: In my ten years here at UPMC, it is not often that I come away utterly impressed with the actions of our staff. And that is not because what our staff do daily is not impressive; it most certainly is. But when staff exceed that already high bar, I can honestly say that I am not only impressed, but rather positively astonished by the actions of our DEM staff.

One such situation occurred recently when there was a collision on the Boulevard of the Allies, just outside of the hospital, where victims ended up on the lawn of the hospital. Our team from the DEM was first on the scene to assist those awaiting EMS arrival. What I witnessed was the epitome of professionalism. Each team member played a part: gathering stretchers and supplies, moving patients out of rooms to make space available, coordinating the department, providing care to DEM patients already present, and directing medics and police on scene. What could have been an uncoordinated disaster transformed into a symphony of staff performing, under stress, at their absolute best because of the actions of each member of the DEM present that night. And after the excitement had settled, each DEM staff member went about their night, performing the duties as needed and providing the care expected of them to each patient present within the DEM. Despite the stress, the anxiety, and the excitement that came with the collision, no patient was overlooked. The staff continued to put their patients’ needs ahead of their own and to perform their role above and beyond even my elevated expectations. 

The ability of a group of people to do remarkable things hinges on how well those people can pull together as a team. I can think of no team within UPMC Mercy that exemplifies the extraordinarily compassionate care that underpins a DAISY Award nomination more so than the ED nurses, physicians, and staff. It is for this and many other reasons that the Department of Emergency Medicine team is receiving the 2024 DAISY Team Award. We are grateful to work with such an outstanding team at UPMC.