Rotating in the Emergency Department at Hospital Universitario San Ignacio

Jeffrey Chen, M.D.
Resident in Emergency Medicine at MGH/BWH
PGY 2

February 6, 2019

In my time here in Colombia, I’ve had a few main goals. Firstly, I’ve spent time in the emergency department at Hospital Universitario San Ignacio, the primary teaching hospital of Pontificia Universidad Javeriana in Bogotá. Every year, this department sees about as many, if not more patients than the MGH ED, totaling about 120,000-140,000 patients per year. Just like the MGH ED, it’s a busy place divided similarly into a resuscitation area, an evaluation area, a clinical decision unit, an observation unit, and a pediatrics department.

Outside the Hospital Universitario San Ignacio, hospital leaders set up a candlelight vigil, with each candle representing the healing of a patient in the hospital.

Of course, with the emergency medicine curriculum being so standardized, there are far more similarities than differences in the way the department functions. A patient with a displaced leg fracture, for example, will be evaluated first by an emergency physician who will perform a neurovascular exam and provide initial pain control before calling an orthopedist to help reduce the fracture. A young patient coming in cardiorespiratory arrest from asthma will have half the staff in the resuscitation area descend upon them to obtain vascular access, perform CPR, run the code, etc.

Moreover, there is an academic conference day each Friday filled with lectures on topics ranging from chemotherapy toxicities to priapism to medication overdoses. There is a simulation center to practice procedures such as central line insertion as well as trauma resuscitations. This center even has a model of a destroyed car to practice extractions from the scene as well as out of hospital resuscitations.

 A destroyed car donated to the simulation center allows trainees in emergency medicine and nursing to practice field extractions and resuscitations.

I’ve also been keen to observe some of the differences in practice. Patients in this ED spend a lot more time boarding there than here, as much as we have a problem. For example, I saw many patients with myocardial infarctions (heart attacks) go from the ED to the catheterization lab, get a procedure/stent placed, and then come back to the ED to board more. Some of these patients were then discharged directly from the ED, though some were able to go up to the CCU. As a result, the ED docs here know an incredible amount of the literature about MI aftercare, long-term medications after stent placement, etc.

Another thing I’ve been impressed by is the fact that subclavian central access is first-line here. This is due to the reduced rates of infections and DVTs in these lines, though we tend to avoid these in our EDs to the higher rates of pneumothorax. The doctors in the ED at Javeriana however put these in with ease and with confidence.

Overall, it’s been an amazing honor to work and observe here alongside the amazing emergency physicians here in Bogota. It sheds light into the amazing work that has gone into building emergency care systems here to care for patients in their greatest times of need.