ED Programs Reduce Wait Times, Improve Patient Satisfaction
What started as a three-month trial, blossomed into the Team Triage program, which has significantly improved patient satisfaction and reduced waiting times for patients seeking emergency care at Stanford.
As part of a Stanford leadership course, Nounou Taleghani, MD, an emergency room physician at Stanford Hospital, proposed a new concept to her department: put a physician, nurse and emergency department (ED) technician in the waiting area to quickly see patients as they register, determine the severity of their illness or injury and begin their care. What started as a three-month trial, blossomed into the Team Triage program, which has significantly improved patient satisfaction and reduced waiting times for patients seeking emergency care at Stanford.
Soon after implementing Team Triage, the ED launched Fast Track, staffed with its own set of emergency physicians, nurses and techs, to give prompt attention to patients with minor illnesses or injuries. Upon registration in the ED, low acuity patients are identified by a triage nurse or physician and escorted down the hall to the Fast Track where they are seen immediately.
"The idea of Fast Track is to rapidly find low acuity patients, pull them out of the mix of the general ED and give them the best possible emergency care in the shortest amount of time," says Grant Lipman, MD, medical director of Fast Track. The door-to-doctor time for Fast Track patients averages about 18 minutes. And most of these patients are out of the emergency room in a little over an hour.
Both programs operate during peak hours – Team Triage from noon to 8pm and Fast Track from 11 am to 11 pm – to streamline patient flow through the ED at its busiest times.
Since these two programs were introduced to the ED more than a year ago, the number of patients who leave without being seen has dropped from the industry average two percent to 0.65 percent. And patient satisfaction has risen dramatically. For Fast Track, the likelihood to recommend has peaked at the 99th percentile. The likelihood of patients to recommend the ED overall has soared to the 91st percentile up from the 72nd percentile two years ago.
And all of this is occurring in an ED that's filled to capacity. Last year, Stanford saw a record 54,000 patients in its emergency department. That's an average of 160 patients every day, in a space originally built for 70 per day. And though patient volume has consistently gone up, the ED is now seeing patients in shorter time frames. "We're busier, but we're learning how to be more efficient about how we provide care," says Patrice Callagy, RN, patient care manager for the emergency department.
Getting results like these took effort. Stanford applied strategies from the business philosophy of lean management to streamline every step of the ED experience that doesn't have value for patients, says Marlena Kane, director of strategic operations, patient care services. "Team Triage and Fast Track bring the value of the whole experience – that of seeing a physician or nurse – up much earlier in the process," she explains.
Team Triage and Fast Track bring the value of the whole experience – that of seeing a physician or nurse – up much earlier in the process.
The Team Triage team sits in the waiting area, the physician behind a partition directly across from the registration area, which allows the doctor to see the patients as they come in. "That gives me an immediate opportunity to put my eyes on a patient," says Taleghani, medical director of Team Triage. "You can get a lot of information with an experienced set of eyes."
These same triage doctors can start labs, place orders and get patients receiving pain medications long before an ER bed opens up. They can also quickly identify patients with stroke symptoms and call a stroke code even quicker than before. There are treatment chairs behind a partition in the lobby where this initial assessment and care is given.
"When the ED is full and no beds are available, the patient's treatment can begin in the waiting room," says Taleghani. "Having this team speeds up patient access to a physician, which maximizes flow for all patients."
Team Triage and Fast Track are also very physician satisfaction driven, Taleghani and Lipman both point out. Physicians in the community or here at Stanford can call the Team Triage or Fast Track doctor on duty if they have a patient they want to bring in for a quick examination or evaluation. This phone call can help facilitate the patient visit, and the ED physician can call the referring doctor back with an update.
"Patients tell us this is the best ER experience they've ever had," Lipman adds. "They come in expecting to wait because they're not that sick, but they are actually seen first. Stanford is known as where to come for complex medical problems," he says. "But we want patients to know we’re here for every problem they might have."
By Grace Hammerstrom