Dr. Jeffrey Zack charts change in hospital ER

On a recent Tuesday afternoon in January the Martha’s Vineyard Hospital Emergency Room was quiet. No one sat in the waiting room. One person was in a treatment room.

The three veteran Island nurses on duty moved with confidence and self-assurance, important attributes in a job where there is no way to predict what medical emergency the next hour will bring.

Dr. Jeffrey Zack, emergency department director, was dressed informally. Speaking to The Times about the ER during a recent tour, his casual Island demeanor mixed with professional focus as he discussed the challenges and rewards of his job.

Unlike the old emergency room, there are separate entrances for ambulances and walk-in patients. A major trauma resuscitation room is located across from the nurse’s station. “That is the room where we like to handle most of our emergencies,” Dr. Zack said.

Two other rooms are equipped for major medical emergencies. A triage room located next to the walk-in entrance provides a space where patients receive an initial evaluation. “The meaning of triage is ‘to sort out,'” Dr. Zack explained.

There are 16 treatment rooms in total and an additional nurses’ station at the rear of the department, now utilized only in the busy summer months. In general, the busiest day is Monday and the busiest time of the day is between 10 am and 6 pm, according to ER records.

During the winter months one doctor and three nurses are assigned to the ER. In general, each doctor works a 7 to 7, 12-hour shift.

Currently, the summer schedule adds a third doctor who is assigned to a 10 am to 10 pm shift, providing double coverage during the busiest time of the day, and the nurse staff increases to four or five.

That schedule is expected to change with the addition of physician assistants and a fast track designed to provide expedited care for patients with more minor problems.

Just feels right

Dr. Zack lives in Oak Bluffs with his wife and three children. He arrived on the Island in July 2002 straight from a residency in emergency medicine at Brown University School of Medicine at Rhode Island Hospital, part of a crop of new doctors the hospital hired.

“I always thought this was a special job when I took it. I’ve been here 8 years and the average turn over for ER docs is two to three years,” he said. “That speaks volumes for me being here.”

He continues to return to Rhode Island Hospital to keep his emergency room skills sharp, but said he has set his roots in Oak Bluffs.

“This has been a really wonderful experience for me coming out of a residency that is in a very busy inner city ER,” Dr. Zack said. “It is just a different way of practicing emergency medicine. You can take your time with the patients. Get to know them a little bit more and thus deliver what I think is better, safer, and more effective care.”

Dr. Zack said at many large hospitals there is pressure to move people through the emergency department as quickly as possible. That can have both a positive and negative effect on patients.

Martha’s Vineyard Hospital is owned by the Partners HealthCare Network and affiliated with Massachusetts General Hospital, and linked electronically to Boston’s world-class medical institution. But Vineyard Sound presents a physical barrier that amplifies the advantages of working in a large medical institution as opposed to a small island hospital.

The biggest challenge Dr. Zack said he faced when he came to Martha’s Vineyard straight from his residency at Rhode Island Hospital was learning how to work without all the resources available at a mainland hospital, even a small one.

For instance, “You can get an MRI whenever you want; you have a neurologist, a cardiologist available. We don’t have that here and it makes you a better physician. You have to think a little harder. You have to spend that extra time to think about, well, who do I have to ship out of here today and how do I get them there? And sometimes you can’t. It’s 11 pm at night and there’s a northeaster blowing in, and you have the job of taking care of a very sick patient. It’s not something you would usually do at another hospital.”

Dr. Zack was asked to become emergency department director following the departure of Dr. Tim Tsai last May. In his new job he works closely with the director of nursing.

Dr. Zack said there is a strong team approach.

“I would not have taken the job if did not feel right,” he said.