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Emergency Department Efficiency

Jim Molpus, for HealthLeaders Media, December 13, 2013
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"Rapid assessment puts the patient in the middle of the entire process," says Luis Lobón, MD, site chief of emergency medicine at CHA's Cambridge and Somerville Hospital campuses. "Everyone goes to the patient for the elements that they need to complete. So the registrars will do bedside registration. The nurse may do an initial screening or triage at the bedside, but that could be at the same time as the physician or mid-level provider who is already evaluating the patient and making some decisions on management and disposition. So as opposed to waiting for everyone to complete a task, everyone is doing the task simultaneously to expedite care."

For all the improvement that the rapid assessment unit brought to patient flow, it was an extra step, which is why CHA eliminated the rapid assessment unit—but not the concept—in its Cambridge and Somerville EDs last year.

"Because we made the whole ED a rapid assessment unit," Sayah explains, "we found that we had become so efficient in the turnaround time that stopping at rapid assessment was actually slowing down the process. So now 'a bed is a bed' for our whole ED, and the patient's going to any ED
bed—regardless of their acuity—and getting care immediately without this two-step process."

The new process, without the stop at the rapid assessment unit, still begins with the patient partner, who does the mini-registration and gets the patient back to an ED bed. The nurse will then talk to the patient and do "a triage note, but it's actually the first nursing note," Sayah says. Usually the physician goes in right after the nurse, but sometimes they will go in at the same time. Either way, the door-to-physician time is under nine minutes, he says.

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