How does it work? Say Patient X presents at the ED with belly pain she's had for three weeks. The first stop is a quick look, where a registered nurse assesses the patient's condition and assigns an Emergency Severity Index number to route the patient through the ED.
If the vital signs are stable (an ESI of 3–5) then the patient sees a physician and RN together for assessment and testing. Patients don't return to the waiting room to await test results; instead they go to a continuing care area so an RN can monitor their vital signs and reaction to medication. The patient receives a pamphlet explaining the process, and care providers must check off each step in the patient's pamphlet.
"The idea is the patients who are less sick move through the process quickly," Johnson-Kelley says. "These patients only use 12 of our beds in the ED. However, there are small wait areas for the other steps in the process."
Contrast the process for patients with an ESI of 1–2 (critical care). If Patient Y comes in with chest pains, he bypasses the intake process and an ER technician performs an EKG and works to differentiate the type of chest pain.
"The beauty of this is we decrease the risk for the acute care patient in getting them from lobby to bed," Johnson-Kelley says.
But even acute care patients don't "own" their beds, she explains. If the patient stabilizes, he is moved to continuing care so the bed can be used by the next acute care patient.