Communicative Emergency Care After Traumatic Accident

After sustaining injuries from falling construction supplies, a Silver Lake social worker found much-needed help at USC Verdugo Hills Hospital’s emergency department.

Stacey Zionts knew that taking long walks around Silver Lake before dawn came with certain risks.

But these walks were also an important part of staying fit, both mentally and physically, so she did what she could to mitigate potential hazards. She routinely wore a neon vest to be visible to drivers, carried a whistle in case she needed to sound an alarm and always brought a trusted friend — her dog, Bert.

But there was at least one potential hazard she never anticipated.

She never expected that another early riser — a man working on a billboard — would drop a massive, weighty tarp on her, and that he would later inadvertently hit her with a piece of construction equipment while trying to retrieve his tarp. The impact knocked Stacey unconscious.

The search for emergency care

After regaining consciousness, Stacey and Bert managed to walk home, though she was dazed and bloodied and didn’t know what had happened. When she opened her front door, Stacey’s partner, David, could see something was wrong, but all Stacey could offer was: “I think I got hurt.”

David didn’t waste any time. He could see Stacey needed medical attention and took her to a nearby emergency room while he set off to find out how she got hurt. Luckily, her unusual accident was caught on video by a building across the street.

At a nearby emergency room, Stacey learned that she had fractures in two of the vertebrae in her neck and one in her back, for which she was prescribed pain medication.

But when the medication did not relieve the pain, nausea and extreme sensitivity to light she was experiencing, she and David visited a different emergency room. This time she received anti-nausea medication, which also didn’t resolve her symptoms.

“It was extremely frustrating. At both places, they noted that I was injured and in extreme pain and sent me home no better than before,” says Stacey, who is a social worker at a hospital. “I didn’t feel like I was getting the help I needed.”

Stacey decided to give one more emergency room a shot, since she was not getting relief. This time she went to USC Verdugo Hills Hospital, where she was initially seen by emergency nurse practitioner Donna Coimbra-Emanuele, FNP-BC, ENP-C.

Communicative, thoughtful emergency care

Coimbra-Emanuele listened closely to Stacey’s story, including the details of her accident and prior emergency room visits. She asked many questions about Stacey’s medications, how she responded to them and about every symptom she had experienced since her accident.

“It was the first time anyone really tried to understand everything I was going through and I could tell that she genuinely wanted to help,” Stacey says.

By definition, emergency rooms can be stressful and chaotic places. Jonathan Crabb, MD, medical director of the emergency department at USC-VHH, says that practicing good medicine, even in an emergency room setting, begins with listening to patients.

Investing time with patients in the beginning helps practitioners understand what needs to be addressed and how to treat them or provide them with proper referrals, Dr. Crabb says. It also helps ensure patients like Stacey do not make return trips to the emergency room, which is an important indicator of the quality of care of an emergency room.

“Communication is extremely important in an ER and something we really try to keep at the core of our practice,” Dr. Crabb says. He also notes that listening to patients can obviously reveal important nuances that guide how they are treated. According to Dr. Crabb, it has also been shown to affect outcomes for patients.

“There is an abundance of evidence that if people feel like someone is listening and they feel cared for, their condition improves,” Dr. Crabb says.

Finding the missing diagnosis

By listening to Stacey, the staff at USC-VHH were the first to figure out that she had a serious concussion from the accident and that because she wasn’t responding normally to standard pain and anti-nausea medications, she needed a higher level of care before she was likely to improve.

Ultimately, Stacey was admitted to USC-VHH for a few days. During that time, the medical staff figured out she needed a novel combination of medications to combat both her nausea and her pain.

“They were the only ones to figure out that I needed to be treated — not sent home,” says Stacey, whose pain, nausea and photosensitivity all subsided while she was under the care of the staff at USC-VHH. “I am really grateful for the care I received at USC-VHH and that they really went beyond the ordinary to try to help.”

Several months after getting past the initial pain and discomfort from her accident, Stacey had surgery on her cervical spine to fuse and stabilize the vertebrae in her neck.

The surgery went well and she hopes the procedure and physical therapy will help her return to the athletic lifestyle that she lived before her accident.

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