Case Study #5: Virtual ED/Emergency Physician in Triage

EMERGENCY DEPARTMENT SETTING:

KEY CONCEPTS:

Move initial physician evaluation “forward”
Rapid initiation of diagnostics
Patients see physician earlier in visit
Create “virtual ED beds” with fast turn-over
Quick and simple disposition of very minor patients, reserve valuable bed space
Second initial assessment, early in visit, to back-up triage nurse and reduce triage error

PROCESS:

Patient presents at front desk
Two nurses provide “quick look” triage
If a true emergent condition is identified, patient is immediately taken to appropriate treatment area (usually critical medicine/trauma)
Otherwise, clerk simultaneously takes minimal information to match medical record number or creates new number, and enters patient into tracking system
Patient is then fully assessed and triaged
Majority of patients then go to the virtual ED composed of two beds and staffed by an ED physician and nurse
Level 3 patients typically have work started (i.e., lab, x-ray, CT) and are then sent to the main Emergency Department for further treatment and disposition
Level 4 & 5 patients may be quickly treated and discharged from Virtual ED, or can go to Fast Track for minor procedures, etc.
Allows ED Physicians and Fast Track Nurse Practitioners to pick up patients that are already in process and ready for further treatment and disposition
When the main Emergency Department or Fast Track are at capacity, patients may return to waiting room until treatment space is available; however, work-up is in progress

RESULTS:

Reduced patients who leave without being treated (LWBS) by more than 50%
No additional ED staff resources required – some of the work load starting diagnostic work-ups shifted to virtual ED, and staff shifted with that work load
Reduced triage error, especially under triage resulting in ill patients in waiting room
Reduced congestion in main Emergency Department, with minor patients never moving past Virtual ED
Extremely valuable during peak volumes and high occupancy
Physicians in virtual ED rotate shift equally with other ED docs and are paid an hourly rate

Case Studies