Reengineer triage for improved ER efficiency

A patient with a toothache and a patient with a stomach ache both go to the emergency department. Until providers assess whether they are truly emergent cases, both are typically treated the same--waiting in the ED for hours.

To help streamline emergency cases, Cambridge (Mass.) Health Alliance reengineered its ED process, eliminating the traditional triage and registration, HealthLeaders Media reported. The result: An average length of stay for rapid assessment patients of about an hour, door to door, and increased patient satisfaction scores from the 15th percentile to the 65th.

Even though there were ED beds, the problem was in the process. "Historically, when patients go to emergency departments, they walk in and they're confused," Assaad Sayah, chief of emergency medicine and president of the medical staff, told HealthLeaders. "There's nobody to talk to them.

The new process generally occurs in the following order for less acute patients:

  • "Patient partners," who are multilingual nonclinicians, greet the ED patient and ask him or her for a name, an identifier such as a birthday or Social Security number, and chief complaint, entered into the computer. The process takes roughly two minutes.
  • A nurse and an ED tech conduct rapid assessment that combines the traditional triage, registration and express care, ranking patients on a scale of acuity from 1 to 5.
  • A physician assistant orders diagnostics, while full registration is completed.
  • The nurse discharges the patient from the room.

In addition to improved patient satisfaction scores, the reengineered process meant that fewer patients left the ED without being seen, dropping from 4.04 percent in 2006 to 0.68 percent in 2011, HealthLeaders noted.

Reengineering the ED process also could help improve wait times with implications for patient outcomes. A British Medical Journal study last year found that the longer the patient stayed in the ED waiting room, the more at risk he or she was for an adverse event, FierceHeathcare previously reported. "For every extra hour of mean length of stay in an emergency department, in similar patients at the time of presentation, there is an association with increased seven-day mortality and admission to hospital in those who are discharged home or leave without being seen," according to the study.

For more information:
- read the HealthLeaders Media article
- see the BMJ study

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