"We actually know our number of patients who stay in the same room they started in is around 85%," Becker says. "For that reason, what's great is that the nurse who cares for you during your ED visit is usually the nurse who triaged you. That's another nice feature of not having multiple handoffs during the same ED visit."
Overseeing all of this ED flow, Sayah explains, is the charge nurse, who has no clinical assignment. "The charge nurse's job is to make sure that the flow is there, that the next bed is available, that the patients that need to be moved are moved and to drive the process," he says. Sometimes driving that process may mean driving the physicians a bit, too. "It's not unusual for the charge nurse to go to the ED doc and say, 'These people have all the labs ready. Let's see if we can find the disposition.' Does it happen for every patient? No. Most of the time, we physicians are on top of it. But sometimes, depending on how busy the place is, the layer of oversight is the charge nurse."
Being able to keep the same nurse with the patient is a result of redefining nursing roles so all ED nurses can take patients, rather than a traditional model of some nurses who take triage and others who provide nursing care, says Charlene Scarpa, RN, CHA's associate chief nursing officer of emergency, perioperative, and procedural services. Roles are less important than making sure all of the nurses have "critical-thinking skills," Scarpa says.