While the less acute patient is in the rapid assessment room, the physician assistant orders whatever diagnostics need to be done. While waiting for results of those diagnostics, full registration is handled. After the patient is treated by the PA or given a prescription, the nurse discharges the patient directly from the room. "The average length of stay for rapid assessment patients is slightly over an hour, door to door," Sayah says.
Patients who are assessed, treated, and discharged straight from rapid assessment make up approximately 40% of overall ED volume at Whidden. Two quarters after the rapid assessment program went live, overall ED patient satisfaction jumped from the 15th percentile to the 65th. Patients who left without being seen—a key metric for waiting room holds—dropped from a peak of 4.04% in 2006 to 0.68% in FY 2011.
Those with higher severity are taken immediately to the main ED where they are assessed and seen by the ED specialists for more advanced diagnostics and assignment to inpatient admission.
CHA's new throughput process allows problems to be addressed with specificity and speed. "The ED tradition used to be one mighty river, so everybody came in and went through the same process," says Nancy Sears-Russell, RN, BSN, MS, associate chief nursing officer for emergency services. "Now it's many, many tributary rivers."
Luis Lobón, MD, site chief of emergency medicine at CHA's Cambridge Hospital campus, says physician-to-nurse communication was also a barrier to good patient flow and quality care when he arrived in 2007. Nurses would do assessments, only to hand off the patient to a provider who would most often see that patient independently.