"We looked for examples of when we were best meeting the patient needs," Stone says. "And we found the experience of an active chest pain patient: The patient arrives. The patient's immediately taken to a bed in the ED. All the team members gather around, listening to this story. Everybody's working shoulder to shoulder getting everything done and expediting the patient care. So what we did was try to use that model for every single patient who arrives to the ED."
With the model determined, the next step was "to adopt the philosophy that triage is not a location, it's a function," Stone says. "The philosophy became that patients presented and they were taken to a bed."
A change in philosophy meant a change in workflow. Some hospitals across the nation are adopting an ED "ambassador," a nonclinical role to greet patients and get basic information, and also supplementing physicians with midlevel providers to take simple cases. But Sharp decided to continue with the same staff mix.
"We don't use nurse practitioners," says Christopher Walker, MS, RN, NP, CNS, director of emergency services at Sharp Memorial Hospital. "We're a physician-only model. We contract with a physician group and they chose no midlevel providers. When you walk in the door, you are walking in to talk to a nurse, not an ambassador. It is a specially trained ER triage nurse. They are taking that basic registration information, but they're also already making that first-level assessment that's at a higher level than any ambassador could."