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Tom Gagen
Chief Executive Officer
Sutter Medical Center

Sacramento, CA-based Sutter Medical Center uses a rapid medical exam to speed patient flow in its busy emergency room. Tom Gagen explains the process, implemented a year ago, and how it helped Sutter improve patient safety and satisfaction during peak times in the ER.

Gagen: Between two sites, we see about 80,000 emergency room patients annually. We've seen our daily census go from about 100 patients a day to 135 over a couple of years at Sutter General Hospital. We were having some throughput problems in taking too long to see patients and having low-acuity patients tie up beds.

Say I'm a typical patient, and I come in. The first thing I usually see is a triage desk with a nurse. During the hours of rapid medical exam, at that triage desk is a nurse and physician. That nurse is getting my vital signs, my symptoms, my history. The physician's doing a very quick medical exam: listening to my symptoms, seeing what my causes are. Basically he's making a decision whether I need to be seen as a regular ED patient or if I'm a lower-acuity patient. I'm not tying up an ED bed waiting for the process—I've been seen and screened. I'm back out waiting for things to come back for a definitive diagnosis.

It's let us see more patients, turn those beds over, decrease the number of left-without-being-seen, and decrease diversion hours. From the patient safety side, it helps us get more acute patients to the ER quicker. It puts the patient at the right level of care.

—Molly Rowe