BACKGROUND
CHALLENGE
The WGMC ED was experiencing high arrival to provider times and low patient satisfaction scores.
APPROACH
The WGMC ED team added a triage nurse in the lobby and an APC to the Rapid Screening Area during peak times.
Triage Nurse in ED at Peak Times
In the WGMC ED, approximately 165-patients are seen per day, which is more than 5,000 per month and approximately 62,000 annually. Peak times occur between the 12-hour span from 11 a.m. to 11 p.m. During peak hours, it is not uncommon for the waiting room to fill up quickly.
With the support of the hospital, the ED team was able to focus on changes to be made inside of the department, starting as soon as a patient is checked-in.
Previously, a triage nurse was placed in the lobby one day a week, often resulting in increased wait times and low patient satisfaction scores during peak hours. Now, the triage nurse is in the lobby and an Advance Practice Clinician (APC) is in the Rapid Screening Area seven days a week during all peak times.
The triage team assesses the patient, assigns a 1-5 ESI level, and then closely monitors any patients without immediate bed availability in the waiting room. If the patient’s condition appears to worsen or he/she begins to experience increasing levels of pain, the team can quickly recheck vital signs and determine if the patient needs to be moved to a room sooner. With this approach of rapid patient assessment at peak volumes, the physician, APC and nursing team can determine initial treatment options quickly after patient arrival. Many times, they may even disposition the patient from the waiting room prior to the patient ever reaching a bed.
- Level One: Patients with life-threatening/critical condition(s) and/or patients who are unresponsive. This level is immediately bedded.
- Level Two: High-risk patients with unstable vital signs. These patients are experiencing severe pain or sickness.
- Level Three: Stable vital signs but significant discomfort and/or sickness is present. Often more than two resources are needed to make patient disposition.
- Level Four: Low risk patient with stable vital signs. One resource is needed to make patient disposition. Often treated through fast-track, if available at the facility.
- Level Five: Low-risk patient with stable vital signs. No resources are needed. For example, a patient needing a prescription or a patient needing a cut stitched. Patients at this level are often seen through a fast-track, if available.
WGMC’s average ESI acuity level is approximately 3.4, meaning a majority of patients are presenting to the ED with conditions in the three to four acuity level range. Most commonly, these are the patients sitting in the waiting room too long. These patients need treatment which requires more than a prescription but is not considered life-threatening or unstable.
WGMC’s ED is a very dynamic environment. Some days only six percent of patients are admitted, other days 19 percent of patients are admitted, with large variations in required resources from day to day.
“We’ve implemented the waiting room triage initiative to help with patient throughput,” said Ferner. “This team greatly contributes to decreasing the length of stay (LOS) for our patients, but also greatly contributes to increasing patient satisfaction scores. We are happy to have the support of the hospital and Veronica’s team as we continue to provide world-class healthcare to our community.”
RESULTS
Veronica Hopster received her Bachelor of Science in Nursing from LaGrange College in LaGrange, Ga. She has worked in the emergency department for thirteen years, nine of those years at the bedside as an ED nurse and four years in a leadership position. Veronica is trained in LEAN concepts and received her Lean Six Sigma Green Belt in 2017.
Veronica currently serves as the Director of Emergency Services at WellStar West Georgia Medical Center in LaGrange, Ga.
Dr. David Ferner received his bachelor’s degree from Heidelberg College in Tiffin, Ohio and his medical degree from the Medical College of Ohio in Toledo. Dr. Ferner completed his emergency medicine residency at St. Vincent Mercy Medical Center, where he later joined the faculty and served in his first leadership position as the LifeFlight Medical Director. While at St. Vincent Mercy Medical Center, he dedicated his time to educating residents, advance practice clinicians, students and nurses in the Department of Emergency Medicine as a Clinical Assistant Professor.
Dr. Ferner’s passion for education has been a significant part of his career as he has lectured hundreds of hours on a variety of emergency medicine topics. His motivation to continually develop his clinical practice and teaching others resulted in countless hours of research and written manuals focusing on Diagnostic Ultrasound in the ED, as well as several other diagnostic algorithms and pathways. In 2017, Dr. Ferner authored a combination memoir and guide for others with MS, Doctor, Heal Thyself: A Physician’s Journey of Discovery, Acceptance, published on Amazon.
Dr. Ferner brings more than 20 years of medical practice and leadership experience to the ApolloMD team. His dedication to improving ED operations, patient throughput and flow and enhancing patient experience has led to several career accomplishments including the development of an accredited Chest Pain Center, development of ICU Multi-Disciplinary Rounds which aligned facility-wide operations, and developing and implementing a narcotic abuse screening tool for ED use.
This continued dedication has also greatly impacted the WellStar West Georgia Medical Center emergency department where Dr. Ferner currently serves as Medical Director. Dr. Ferner is board certified in emergency medicine and a fellow of the American College of Emergency Physicians.
