Carlos Flores, MD: A Valuable Asset to NewYork-Presbyterian/Lawrence Hospital’s Emergency Department

Tuesday, September 2, 2014
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While attending high school in his native Puerto Rico, Carlos R. Flores, MD, FACEP, Director of the Department of Emergency Medicine at NewYork-Presbyterian/Lawrence Hospital, knew he was destined to become a physician.

Although he finds it hard to pinpoint exactly what drew him to medicine, Dr. Flores recalls having a fascination with the sciences and excelling in them.

After medical school, Dr. Flores began pursuing general surgery — “a fantastic field” — however, he discovered during one of his residency rotations to the emergency room that he was intrigued by emergency medicine and felt compelled to make a switch.

“It appealed to me more in terms of what I wanted to do,” he says. “The clinical challenges were somewhat different — from children to adults, from lumps and bumps to strokes. There’s a real breadth of pathology that we have to deal with.”

Dr. Flores has embraced the demands of emergency medicine and has found his home for the past 15 years at what is now NewYork-Presbyterian/Lawrence Hospital.

A New Legacy of Care

NewYork-Presbyterian/Lawrence, a 291-bed acute care facility with more than 400 physicians, is celebrating 105 years of service this year. Another significant milestone was reached on July 1, 2014: Lawrence Hospital Center joined forces with NewYork-Presbyterian Hospital to establish a new working relationship with Lawrence to officially become NewYork-Presbyterian/Lawrence Hospital. The closer affiliation of the two institutions aims to enhance care, improve access and lower healthcare costs for residents of Bronxville and surrounding communities in Westchester County.

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Danielle LeStrange, MSN, MBA, RN, ACNS-BC, Director of Emergency Nursing and Clinical Outreach, and Srirama Kalapatapu, MD, confer with Rose Ann O’Hare, Senior Vice President & Chief Nursing Officer.

The gateway to the hospital has often been its Emergency Department, which is staffed by board-certified emergency medicine physicians who treat a variety of injuries and illnesses in both children and adults.

“When I look at our emergency physicians, they are bright, very independent, compassionate and professional. On top of that, there’s a very big dose of excellent people skills,” Dr. Flores says, noting that emergency medical staff must deal with almost everybody every day — private physicians of different specialties, every department within the hospital, outside agencies and, of course, the patients.

In addition to the emergency department physicians, there is a large team of specialists who also provide round-the-clock care to those who come to the hospital with an emergency.

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Collaboration and communication are crucial. Every staff member of the NewYork-Presbyterian/Lawrence Hospital Department of Emergency Medicine puts patients first and plays a critical role in the delivery and quality of patient care.

“We have OB/GYNs, pediatricians, hospitalists and intensivists who are trained to give specialized care to patients 24/7,” says Dr. Flores.

He adds that the Emergency Department nurses are “second to none.” They are well educated, skilled and have advanced certifications.

“The majority of our nurses are trauma certified, and many are certified in advanced cardiac and pediatric life support. You have to have a calling to do what our team does, and they do it well,” says Dr. Flores.

Rewards and Challenges

For Dr. Flores, it is rewarding to have the opportunity “to do a little bit of everything” as an emergency room physician and to feel that “you’ve done the right thing.

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Andrine Coombs, RN, Assistant Nurse Manager, and Zilpha Allen, RN, share a light moment.

“Here at Lawrence, I think the cases that are most memorable are the ones where a resuscitation is successful,” Dr. Flores says. He also cites the patients who are treated at Lawrence’s stroke unit.

“When that process works well and you see the patient improve in front of your eyes, that’s very rewarding,” he says.

Obviously, there are also many challenges to confront: the intense stress of having to treat patients quickly in life-or-death situations, dealing with the loss of a patient, forging relationships with patients and their families, and gaining trust in a very short time frame.

“The amount of attachment we have to the patients is brief,” Dr. Flores points out. “The patient might arrive in cardiac arrest, so we’re very disconnected from that patient and the family.”

This is what makes emergency medicine very different from other fields of medicine, he emphasizes, recalling an inspirational medical school professor who was an oncologist.

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Many community organizations, such as the Generoso Pope Foundation, are appreciative and generous supporters of the Emergency Department and the patient care that physicians and staff deliver.

“This doctor was so attached to his patients and their families; he would shed a tear pretty much with any death, and he would try to go to the funerals. I always remember that as being a wonderful thing. We don’t have that luxury in emergency medicine.”

Within the context of emergency medicine, however, Dr. Flores emphasizes the importance of compassion and sensitivity.

“With the death of a patient, you have to go back to that skill and that compassion to walk a family through the death of a loved one, particularly when you have no connection with them or have never seen them. … I think we have the training to do the right thing; we have the resources to do the right thing. And we have the compassion that allows us to be sensitive to that moment in time.”

Enhancing Emergency Care

A significant improvement to the Emergency Department includes the creation of a new program called MDIT. The “doctor in triage” program, as it’s also known, was created in part by one of Dr. Flores’ colleagues, Ingrid Mudge, MD, Assistant Director of the Department of Emergency Medicine. It’s an evaluation area where physicians can see patients with non-emergent conditions.

“Because these patients don’t have life-threatening conditions, they would typically be seen after our more seriously ill patients. MDIT changes that by helping us to identify these less seriously ill individuals, and treat them so they can go home sooner,” says Dr. Flores.

The MDIT program also includes a newly renovated “Pending Results Waiting Area” where patients who are anticipating test results can sit comfortably. This not only provides a private and restful environment for these patients as they anticipate the outcome of a lab test or MRI, but it also frees up exam rooms for other patients who haven’t been seen by the doctor.

“We’re always looking for ways to enhance our emergency care. This is just one example of how our team is committed to putting patients first at Lawrence,” says Dr. Flores.

Upgrades and Improved Efficiencies

Other recent improvements include cosmetic and navigational upgrades to the Emergency Department. In its main section, the nurses’ station was overhauled to provide more efficient workflows and easy access to computers and other technology.

“We worked with the architects to identify ways to improve efficiencies and enhance the patient experience,” states Dr. Flores. New floors were installed, and a private registration suite was added. This is where the staff treats the sickest patients, those with the most serious injuries and anyone who comes to the hospital by ambulance. It has an isolation room, cardiac monitoring and private rooms.

Another area of the Emergency Department that has gotten a new look is Prompt Care. This is where the patients with the less emergent cases, such as sprained ankles, minor cuts or burns, and ear infections, are seen. Prompt Care has all private rooms. Two are specially designed with children in mind. They each have an ocean theme with colorful murals and flat-screen TVs.

Maintaining a Balance

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More than 42,000 patients visit NewYork-Presbyterian/Lawrence Hospital’s Emergency Department each year.

As for dealing with the stress of his many responsibilities, Dr. Flores admits that he doesn’t use any specific techniques — although he may step out for a few minutes for a quick walk to get something to eat and bring it back. Walking used to be a great stress reliever for him — especially when he was an attending physician and later an Assistant Director of Emergency Medical Services at New York University/Bellevue Hospital. During those years, he would walk almost 40 blocks home from work.

“That was a great walk. By the time I got home to my apartment I was very relaxed. It was particularly fun in 1986 [when the Mets won the World Series], because I would walk past the pubs and stores and they would have the TVs facing out. So if I timed it right with the lights, I wouldn’t miss anything.”

When he is not working, he enjoys spending time with his family. He also likes reading novels and working out. He visits Puerto Rico, which he still refers to as “home,” as often as he can.

Reflecting back on his early training, Dr. Flores attributes much of his success to his mentor, Lewis R. Goldfrank, MD, Chair of Emergency Medicine at NYU/Bellevue.

“Dr. Goldfrank was very supportive and got us going on the right track. There are quite a few folks who have gone through Bellevue who have ended up in some sort of directorship position, so he should pat himself on the back.”

When the young Dr. Flores was applying for medical school, it occurred to him that he should have a plan B, so he applied for graduate school in marine biology. He undoubtedly would have excelled in that field as well, but the many patients he has treated and saved over the years, along with his colleagues at NewYork-Presbyterian/Lawrence Hospital, are altogether thankful he stuck with plan A.

Emergency Preparedness Is a Priority

In addition to Dr. Flores’ shift work and his responsibilities overseeing all clinical and administrative operations, he is also a member of a multidisciplinary team at NewYork-Presbyterian/Lawrence Hospital that meets and trains regularly to improve its response to a natural disaster or mass casualty incident. One doesn’t have to think back very far to recall significant emergent situations that caused chaos, destruction and even death in the Lower Hudson Valley. In recent memory, area residents have had to weather Super Storm Sandy, nor’easters, blizzards and even widespread blackouts. When disasters such as these hit hard, NewYork-Presbyterian/Lawrence is often the place people turn to for medical care, shelter and even emotional support.

“When Sandy hit, we had people who lost electricity and needed power to run their oxygen tanks and dialysis machines,” says John Martin, Director of Security at Lawrence. “There were also those who needed prescriptions filled and the elderly who were just scared and came here to feel safe. We never lost power and even helped out other area hospitals that didn’t fare as well as we did.”

Martin is also the Emergency Management Coordinator and works with Dr. Flores on the hospital’s Emergency Management Committee. The group is comprised of physicians and staff from multiple departments, including nursing, facilities, communications and administration. The committee meets monthly to develop and evaluate response plans to various large scale disasters.

“We participate in drills that are designed to train our staff and ensure we’re prepared for whatever comes our way,” states Martin.

For example, the drills help Lawrence’s Emergency Management Team determine the most effective way to handle patient surges to the Emergency Department after a contagious or contamination event. Also, Lawrence conducts exercises with other hospitals; federal, state, and local agencies; and the schools nearest to the hospital.

“It’s important for the community to know that we’re constantly working to be prepared for any kind of disaster. Life is unpredictable. But at least we know we have a plan in place to deal with almost anything,” adds Dr. Flores.

To learn more about NewYork-Presbyterian/Lawrence Hospital or its emergency services, visit www.NYP.org/Lawrence.