Researchers were able reduce the mean emergency department (ED) length of stay (LOS) by 15% after combining triage and Fast Track units, according to a new study published in the Emergency Medicine Journal . In an effort to decrease ED wait times, The St. Louis Veteran’s Association Medical Center (VAMC) performed a staffing experiment, where it tweaked its ED triage protocol. The facility’s policy prior to the experiment was to have each patient screened by a pre-triage nurse. Patients who did not have an emergent condition were referred to resources outside the ED and others were directed to triage. The triage nurse would interview and evaluate the patients to determine if they needed treatment in an ED bed or if they could be treated in the Fast Track Unit. The new policy effectively cuts out the middle man, consolidating the triage department and the Fast Track unit. Patients are still screened by the pre-triage nurse, but moderate to high acuity patients are moved directly to an ED bed, bypassing triage. Lower acuity patients are directed the new triage/Fast Track area where a physician or nurse practitioner (NP) will treat and discharge them. The physician treats the higher acuity patients from that group while the NP cares for patients with less serious conditions. Upon further evaluation, the physician or NP may also move the patient to the ED floor if he or she believes such care is required. The new approach reduced ED LOS for two reasons.
- Patients encountered providers earlier in the visit, meaning some treatment decisions could be made earlier in the patient encounter.
- Fewer patients required ED beds, allowing more resources to be available for patients who required them.
This model could help hospitals that are looking to improve their ED throughput. With the Affordable Care Act expected to extend healthcare coverage to another 30 million Americans, the ED crowding problem is not likely to go away. The physician shortage means many of those patients will use the ED as their primary care provider. Barton Associates is positioned to help hospitals staff their triage and Fast Track Units with top-quality locum tenens physicians and NPs. Our team has placed locum tenens emergency medicine NPs from our talented pool of providers to help improve throughput at facilities nationwide. For more information visit our facilities page.
