"Critical-thinking skills need to be the hallmark of a skilled emergency room nurse," Scarpa says. "When we have a patient partner at the front who says a patient has abdominal pain, immediately you need to think about three quick diagnoses and know where to put that patient." Those skills are particularly important for the charge nurse, she says. "I'm going to be quite honest: Not everyone can do this as a charge nurse. We know that some people are far better than others when they think about what that person is saying to the patient partner and what really we might be finding. Years ago, I used to be able to sit on the chair and write down a complaint and maybe have a set of labs or an x-ray algorithm that I could go by if they met X criteria. We don't have that now, so this is a very different role that has nurses working at the height of their license."
The overall goal in the patient flow project was to eliminate what Sayah calls the "white space" wasted time between various ED processes where the patient is waiting.
"Our white space is probably the shortest possible, because our total length of stay in the emergency department, door-to-door for all patients, is about 121 minutes," he says. "If you take away admitted patients, that time is about 107 minutes. In those 107 minutes, we are getting all the assessment, all the care, all the labs, all the x-ray, all the intervention, all the treatment, all the communication, and the discharge process. We're shrinking the white space where patients are doing nothing, and that's why we moved the registration downstream, because that's occupying an area of white space where the patient is doing nothing, waiting for the labs to come back."
This article appears in the December issue of HealthLeaders magazine.