No waiting! Time to optimize your emergency department’s efficiency.
Posted by CEP America on Thu, Jan 28, 2010 @ 11:45 AM
By Bonnie Carl, MBA, RN
As the demand for emergency services grows, resources in emergency medicine are being stretched. No surprise, but what's being done about longer ER wait times, overcrowding, ambulance diversion, increased patient suffering and poor morale?
One approach that I'm involved with - and is getting real results in hospitals in California, Arizona, Oregon, Washington, Texas, Georgia and Illinois - is our process known as Rapid Medical Evaluation® (RME). First implemented in 2002, RME is considered a best practice at more than 30 facilities.
RME places one or more providers - physician, nurse practitioner or physician assistant - in triage to perform initial medical screening examinations and either order additional testing or treat and release the patient without ever taking up a bed on the unit. The whole focus of RME is how quickly a provider sees a patient and begins a workup. It's also about how you use space and how patients will flow.
The idea is for patients to be seen in an area of the ED appropriate for their condition. Not every patient in the ED needs to lie down, so if they don't, they might not need a bed. With a triage nurse and a provider working together up front, there can be parallel processing. The patient can then be moved to the internal waiting area. Now the waiting time is productive - it's time spent waiting for results instead of waiting for the next thing to happen.
Having the right people up front managing the process and patients is another important part of RME. Just as some nurses are good at triage and others are not, you really need someone who is good at multitasking, anticipating the needs of the providers and keeping things flowing.
Speaking of flowing - our goal for time to provider is less than 30 minutes, turnaround time for discharge patients of no more than 2 hours, lab and imaging to be less than 30 minutes and the left-without-being-seen rate to be less than 2 percent. And you know what, we're doing it.
At Mercy Medical Center Redding (CA), for example, we saw the door to provider time decrease from more than 40 minutes to just nine minutes within the first month of implementation, and ED patients who left without being seen dropped from 3% earlier that month to .2% - a big boon to hospital revenue.
In my experience, RME works. And thanks to everyone including physicians, nurses, lab, imaging, and registration being on the same page, it will continue to work.
I look forward to your comments!