Palisades updates ER
Hospital’s wait times reduced to around nine minutes
by Tricia Tirella
Reporter staff writer
Sep 20, 2009 | 4025 views | 0 0 comments | 7 7 recommendations | email to a friend | print
Hospital  emergency room  uninsured   health  insurance  North Bergen  Palisades Medical Center
Hospital emergency room uninsured health insurance North Bergen Palisades Medical Center

Palisades Medical Center updated its emergency room this summer and continues to fine-tune the process in order to address the medical dilemma of wait times.

Its emergency room now uses a Rapid Evaluation Unit (REU), where patients are asked questions and given a medical exam by two nurses: a technician and a physician. They often treat two to three patients within around nine minutes of them entering the hospital.

The REU was built onto the Emergency Room this year. It now features digital radiology, a new Picis computer system which allows for rapid delivery of a patient’s history, a Vital Works computer system that gives staff up-to the-minute updates of those in their care, an expansion of patient treatment areas with new cardiac, stroke, and ventilation equipment, and a renovation of patient waiting rooms and staff facilities.

“We realized the old way was not working.” – Gladys Sillero

According to the Institute of Medicine of the National Academies, overcrowded emergency rooms are an epidemic in the United States, with almost 114 million patients in 2003. This was a 26 percent increase in volume over the previous decade. At the same time, 703 hospitals closed and 425 emergency rooms were closed during the same 10-year period.

Treating the uninsured

New Jersey emergency rooms are faced with even more patients since 1.2 million uninsured residents rely on emergency departments as their only source of medical care.

According to Gladys M. Sillero, clinical coordinator of the emergency room department, this greatly impacted the role of hospitals. In the past, patients came to a hospital to recuperate, but hospitals now take the role primary doctors once had.

“I have a lot more people who are unemployed…more people that are uninsured [and] so many of them do not have primary doctors,” said Sillero. “They do not have the time to make an appointment to go to the clinics and wait three or four weeks to get an appointment. They want to be treated now.”

Sillero said that often patients arrive to the hospital sicker since they’ve been treating themselves at home.

Old system not working

Sillero, who has been a nurse for almost 24 years, has worked at Palisades’ E.R. for four and a half years. She is an advanced practitioner, clinical coordinator, and clinical nurse specialist. She also teaches at Montclair University.

Sillero, with the support of President and CEO Bruce J. Markowitz, began to look at how the department could be revitalized, along with the E.R. Medical Director Dr. Alvin Goldberg, vice president of nursing Rueben Fernandez, and her staff.

The emergency room then was crowded with patients often waiting for several hours.

The department hired Dr. Todd Warden, a consultant, who helped them implement the REU last year.

“He started looking at the old ways we were triaging and we realized the old way was not working,” said Sillero.

Triage is the process of choosing which patients are most urgent and need treatment first.

She explained that patients then might be triaged in a “relic” of a room, but afterward they would be sent back to the main waiting room to wait. They key now is to treat people on levels of acuity. Less serious cases are treated and released, while other patients are brought into the emergency room and not left waiting.

They also replaced chairs with beds and lounge chairs for patients.

She said that the wait time is currently now usually no more than 11 minutes.


Sillero explained that new equipment now in place allows her staff to constantly track the status of patients and streamline the process.

The department now even has a pneumatic tube that can vacuum specimens directly to a hospital’s lab.

The old room that was once used to triage patients the old way is now used as a bereavement and education area.

She said that about 70 to 75 percent of patients are non-urgent and area able to fit into this process, but that situation is become more difficult each day since new situations are happening all the time.

“The Rapid Evaluation Unit is working to ensure that every person who steps through our doors is treated quickly and efficiently,” said Markowitz. “It enables our staff to treat patients with minor illnesses and injuries in a special area for quick and appropriate care. It has made a significant impact by streamlining the flow of patients through different units of the hospital.”

She said that her department is staying “on top of its game” and that she truly believes it will take the efforts of all of her staff and hospital leadership to continue to adjust the department’s procedures.

“It’s a learning curve for us because it was a direct change from how triage was done and how it is currently being done,” said Sillero.

Tricia Tirella may be reached at

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