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Emergency Department Triage: A Physician In Triage (PIT) Collaborative Process

By Nicholas Metzger, MBA, BSN, RN; Michelle Gunnett, MSN, RN, CEN; Catherine Prante, MSN, RN, NE-BC; Kevin Daly, MD, FACEP; Bruce Friedberg, MD, FAAEM; and Jaime Rivas, MD, FACEP

Editor's note: When the Palomar Medical Center emergency department relocated to a new, state-of-the-art facility in August 2012, the team anticipated an increase in patient volume. However, patient numbers soon rocketed beyond their predictions, resulting in increased wait times for patients.

To meet this new demand, the team decided to redesign its input system. The initiative has resulted in significant increases in throughput and patient satisfaction. The following report is adapted from a poster presented at CEP America's annual conference in September 2013.

Background

On August 19, 2012, Palomar Medical Center (PMC) relocated to a new hospital and new emergency department (ED). The new ED is a Level 2 trauma center, EMS base station and a STEMI- and stoke-receiving facility. Our projected volume included 75,000 annual visits with an admission rate of 23 percent.

The move increased bed space from 29 to 54 beds. The new ED is divided into three pods (A, B and C), each with a care team that includes an MD, PA, RNs, techs and unit secretaries. The design includes a quick view RN and immediate registration. Direct bedding is done until capacity is exceeded, and then secondary triage is implemented.

Quickly upon settling into our new department, PMC saw a sharp rise above our predicted pattern in EMS arrivals and overall daily patient volumes, which in turn led to rising waiting room times, triage delays and an increase in Left Without Being Seen (LWBS) patients.


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