Emergency Department Reducing Wait Times


Patients entering the Palomar Medical Center Escondido Emergency Department (ED) have been experiencing shorter wait times since staff instituted a new triage system on July 15. The “provider-in-triage model” has cut the overall wait time by 27 minutes and reduced the percentage of patients leaving without treatment from 2.6% to 0.5%.

The benefits of reducing wait times are many: Patients are happier, the lobby is less congested, more beds are available for higher acuity patients and overall care improves as patients receive necessary treatments sooner.

ED wait times had been rising this year as an increase in behavioral health patients and inpatient holds had slowed throughput causing more patients to leave without treatment. From January through June, an average of seven patients per day had been leaving the ED before they were treated, which is possibly detrimental for the patient and public health and not living up to our high standards of care. That number has been reduced to less than two patients per day. In implementing the new triage system, the ED team decided they could make the biggest impact by changing how they processed patients in the front end of the ED.

The new triage model incorporates a “threeage” team including a medical doctor (MD), a nurse and an ED technician. The threeage only treats patients assessed as an acuity level three on a one to five scale. Patients assessed as level threes are those with emergency symptoms, such as chest pain, who need lab tests and medicine, but who don’t necessarily need to be admitted to the hospital. This is the most common type of patient and who the ED team felt like they could make the biggest impact.

An MD assesses the patient in the ED’s front end and writes orders allowing care to begin immediately. The ED tech acts as a type of ambassador, shepherding the patient through the process from getting their labs drawn, transporting to x-rays and assisting the MD and RN with whatever is needed to make the process go as smooth as possible. The nurse continues to play the critical role of medicating, starting IVs and whatever treatments are needed to expedite the patients’ care. The threeage is in place from 8 a.m. to midnight, seven days a week.
Before launching the model full-time on July 15, the team pilot tested the model on select days from April through June at different times and different days of the week. One constant was always increased efficiency, so the data from the first three weeks of implementation has not been surprising.

Emergency Department Nurse Manager Desiree Hadden said it took the cooperation of the entire ED team: administration, physicians, nurses and technicians to bring the plan into place and achieve the success they are having. Working together, they decided to reposition an MD from Pod D to the front end so they could institute the threeage without adding additional MD staff.

While the initial results are encouraging, staff will continue to tweak the process to deliver the best care in the most efficient way possible.

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