Emergency Department Setting

  • Suburban community hospital
  • 27,000 annual ED visits
  • 18 ED beds

Challenge

Reduce door-to-provider time to meet target of less than 30 minutes

Key Concepts

  • Initial provider evaluation occurs early in ED visit
  • Rapid initiation of diagnostic testing
  • Quick and simple disposition of very low acuity patients
  • Reduction of triage error

Solution

  • Patient presents to ED
  • Clerk performs “quick” registration obtaining minimal information to match medical record number or creates new number
  • Patient is triaged
  • If a true emergent condition is identified, patient is immediately taken to appropriate treatment area (usually critical trauma or medical patients)
  • Nurse notifies fast track provider (either physician or advanced practice provider) of patient needing RME
  • Level 3 patients typically have diagnostic work-up ordered (i.e., lab, x-ray, CT) and are  then sent to the main ED for further treatment and disposition
  • Level 4 & 5 patients may be quickly treated and discharged, or can go to fast track for minor procedures, etc.
  • Allows ED physicians to pick up patients who are already in process and ready for further treatment and disposition
  • When the ED is at capacity, patients may return to waiting room until treatment space is available; however, work-up is in process

case-study-9-fig1Results

  • Door-to-provider time consistently less than 30 minutes
  • Faster processing of ambulatory patients through the RME process, allowing lower acuity patients to be seen in the
    low-acuity treatment area
  • No additional ED staff resources required
  • Reduced triage error, especially under triage resulting in ill patients in waiting room
  • Extremely valuable during peak volumes and high occupancy