including rheumatology, pulmonology, and cardiovascular disease. At the same time, the department has played a much more integral part in the education of medical students, instituting a required fourth-year medical student clerkship and taking a hands-on role in the mandatory BootCamps for fourthyear students, as well as providing education for first- and second-year students in the areas of “Basic Life Support,” “Advanced Cardiac Life Support,” and “Universal Precautions.” In addition, an Emergency Medicine Residency Program was launched in 2010, a three-year program, accredited by the Accreditation Council for Graduate Medical Education, that trains 18 residents each year. A clinical site for family medicine and psychiatry residents, the department also provides fellowship training in the areas of Emergency Medical Services/disaster medicine and, most recently, emergency ultrasound. The latter fellowship is a direct result of the incorporation of point-of-care ultrasound into the department’s services—an evolution in care of which Dr. Eisenstein says he is most proud. This type of ultrasound, different from a full diagnostic imaging exam, enables ultrasonography exams to be performed at the bedside in the ED as an adjunct to patient care. It can help clarify findings of a physical exam and serve as image-based guidance for therapeutic purposes. “It was new at the time and involved a lot of negotiations with other specialties, but it’s been a huge benefit to patient care,” Dr. Eisenstein says. The addition of this service also led to the establishment of a new unit within the department: the division of emergency and critical care ultrasound, led by Christopher Bryczkowski, MD ’10, assistant professor of emergency medicine and interim chief. One of the key factors in implementing this new service was gaining buy-in from the medical staff so they fully understood the value of point-of-care ultrasound, Dr. Bryczkowski says. Driven to add emergency ultrasound as a fundamental skill set of emergency providers at RWJ, the department prioritized ED faculty ultrasound training and credentialing in preparation for the incoming emergency medicine residents, says Dr. Bryczkowski, who also directs the emergency ultrasound fellowship program. “Emergency medicine residents trained at RWJ now learn ultrasonography skills, which enable them to provide safe, quick, quality care,” he says, noting that the use of bedside ultrasound by emergency medicine staff at RWJ has contributed to safer patient care. For example, this service allows for confirmation of emergent conditions such as pericardial tamponade, when fluid or blood builds up in the space sur- rounding the heart, preventing it from working properly; ruptured ectopic pregnancies; and abdominal aortic aneurysms, Dr. Bryczkowski explains. In addition, ultrasound guidance can greatly improve the ability to provide IV care for patients who have difficult venous access—improving success rates, decreasing the time it takes for the procedure, and even avoiding unnecessary placement of central lines. E A Continued Evolution of Care mergency medicine practitioners are beginning to take on a much larger responsibility for patients’ health care, Dr. Eisenstein says. Although there has been a lot of stress in the health care industry on preventing unnecessary emergency visits, the real cost savings is not necessarily in keeping people out of the ED, but in avoiding inpatient hospital care, he adds. “One of the dangers of discouraging people from emergency visits is the fact that some serious emergent issues can have benign symptoms. Patients don’t really know if that sore throat is the sign of something really serious,” he explains. “As the role of emergency physicians grows, our expertise will be critical in helping determine the most efficient, safest level of care, whether that is management in an emergency setting or in observation, or admission for inpatient care.” And while Dr. Eisenstein has set his sights on the continued evolution of the Department of Emergency Medicine in each of the medical school’s mission areas, he does so in conjunction with an ambitious hospital expansion project that will physically enhance the department’s ability to meet the growing needs of the community. In March, Robert Wood Johnson University Hospital, one of only three Level 1 Trauma Centers in the state, began a multi-phase project that will increase the size of the Emergency Department from 40,000 to 60,000 square feet and nearly double the bed capacity. Once complete, the new Emergency Department will feature more than 100 private treatment areas for patients, including three additional trauma bays; in-department radiology imaging; an ambulance bay that will accommodate eight ambulances at once; a separate expanded pediatric emergency department; and a treatment area dedicated to patients with less emergent diagnoses. The first phase of the expansion is expected to continue through July 2018. It’s an exciting time for the department, Dr. Eisenstein says, and, like a busy day in the Emergency Department, he looks forward to the challenges these changes will bring: “Every day is different. Even after this many years, it’s fun. I couldn’t see doing anything else.” M Robert Wood Johnson I MEDICINE 23