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Keeping Up With the Changes: Julie Gunnels

3/26/2016


Originally published on Magnolia Banner News
Written by Deena Hardin

Julie Gunnels is an Emerson native and graduate of Emerson High School. Her husband is a welder and machinist at Red Dog Oil Tools, Inc., and they have three children in the Emerson schools. She is a 1997 graduate of Southern Arkansas University's nursing program and has been at work at Magnolia Regional Medical Center ever since.

"I've been in the ER for the past 15 years," Gunnels said. "I've been the director since 2002." Since Gunnels began her work at the old Magnolia Hospital, she has seen a multitude of changes. 

"Things are a lot different. We used to do paper charting, and now everything's electronic. When we first went to electronic, it was very stressful. Some people are not computer savvy, but it didn't take us long. We adjusted pretty well, all of us did," she said. "Usually we have changes every few months with the computer, but everybody catches on. Now, if our computers go down we have to go back to paper. I can't write as fast as I can type now!"

Orders for medications aren't handled in the same way these days either. A Pyxis MedStation dispenses meds after patients register and orders are entered by an authorized person on a computer. "Keeps count, so we're not sitting there counting pills like we used to. Less room for human error," Gunnels said. 

"Our physicians group is staffed through Emergency Staffing Solutions, which is pretty widespread across the southern portion of the United States. They have hospitals they staff in Texas," she said. "All of our physicians here are ER physicians. We have Dr. Damon Edwards — he's the medical director for the ER. The other main physician that we have who usually works Thursday through Monday is Dr. Scott Brown. Our other physicians come from Texarkana or other places through the staffing agency. They fill in for the others if they're on vacation or there's a shift available."

A consultant was brought in to help find ways to reduce wait time in the ER. "A lot of that depends on if we have an emergency come in — a bad car wreck with several victims in it — of course, they're going to take priority over a head cold. We've made some changes. We've installed a motion tablet that connects to each one of our computer terminals. We take that to triage with us and from the motion tablet we're able to tell which rooms we have open. If we have one open, we take the patient back immediately and they don't have to wait. If our rooms are full there will still be a wait until we get one available. That has sped things up for us a lot. But we never know what's going to come through the back door at any time." 

"We are part of the Arkansas Trauma System throughout the state. We're a Level IV trauma center," Gunnels said. There are only two Level I trauma centers in the state, which are UAMS and Arkansas Children's Hospital, both in Little Rock. "All of the emergency department staff and the physicians have all of the training required to be able to take care of trauma patients. We do a lot of intensive training to be able to do that."

"We're also a stroke center. Our stroke program is through UAMS in Little Rock. How that works is if a patient comes in exhibiting signs and symptoms of a stroke, we have two rooms designated for that. We remote in directly with a neurologist, and we start a process of evaluation to see if the neurologist agrees with us to give the patient a thrombolitic [medication] to resolve the clot. We only have a short timeframe — a three-hour window — to be able to do that, according to the onset of their symptoms. We have given it here several times. We have the option of keeping the patient here but we don't have a neurologist on staff, so a lot of times we'll transfer the patient just because they do need a neurologist consult. At any time during their stay here we can remote in with the neurologist." 

Because Gunnels' parents are reaching retirement age soon and have some health issues, being able to care for them locally is a cause near and dear to her heart. "All of our staff who work here in the ER are highly trained in trauma and stroke." The hospital receives state funding for training and equipment for those two programs. 

The nearest neurologists are at the Texarkana hospitals, which are also part of MRMC's network. "It's usually just their preference, where they want to go," she said. "It it is something that's out of our capability to care for, we transfer you somewhere else." 

That process works in a similar way for pediatric emergencies. "We have all kinds of pediatric equipment. We have one crash cart that is specific to pediatrics." The Broselow Cart for children is color coded to use a child's height to determine their estimated weight, which then leads doctors and nurses to color coded medicines and supplies for that child, such as size-appropriate blood pressure cuffs and breathing tubes. The system has become widely used all over the world to prevent overdoses of meds for children. "We utilize that system. We bought the cart with our trauma funds that we get from the state. It's easy for us to take care of pediatrics that way." 

"We can call in to Arkansas Children's Hospital if we have a really sick child here. We have all the technology we need to be able to reach out to other facilities that provide a higher level of care than we do," Gunnels said.

"There is a surgeon that's on-call 24/7 for our trauma patients," she said. Dr. Bob Buchanan and Dr. Moises Menendez rotate that duty. "If the ambulance brings the trauma to us, we have prior notification and the surgeon is here — we call them. That way we have our whole team ready when the patient gets here." 

She reiterated that one of her main goals is reducing the wait time for those who visit the emergency room. With eight single rooms in the ER and one large trauma room that can accommodate two patients at once — as in the case of a parent and child in a car wreck, to keep them from being separated — the implementation of the motion tablet system is helping staff to keep up with what is available. 

Nearly everyone involved with MRMC on every level has been through a training program called Spirit of Excellence. Gunnels said, "It has made a big difference. Even if it's not an ER patient, we just speak to everyone. We want our patients and our families to make sure to feel welcome here at our facility, that we're going to take care of them, and that we're going to provide them with excellent care in a compassionate way."

"We just do little things, like when we discharge them we say, 'Thank you for supporting Magnolia Regional Medical Center' or 'Thank you for your visit today.' Of course, on our discharge papers we have a number they can call if they have any questions. If they get confused about a new medicine or anything like that, we try to make sure that they understand that they can call back. Sometimes, if you go to a facility, especially if it's something bad or your loved one's sick, your brain might not be thinking right. You might have questions afterward. We really do care about their well-being."

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