An Ohio hospital's provider-in-triage model is generating clinical, financial, and strategic benefits, including lowering its rate of ER patients who leave without being seen.
Grandview Medical Center in Dayton, Ohio, has adopted an optimized version of the provider in triage model for its emergency department, increasing the percentage of patients seen by a doctor within 10 minutes from 38% to 71%.
"This allows a provider to get a first glance at the patient and do a preliminary history and physical. The provider can then put in orders for tests that we can get started in the front while we are waiting on beds in the back," says Nikole Funk, DO, medical director at Grandview Medical Center.
After struggling with a triage bottleneck, Grandview decided to try the provider-in-triage model last summer.
"We do have a high-volume, inner-city hospital, and we had just one triage nurse. The process was to triage one patient at a time, then send patients to the back if a bed was available," Funk says. "The triage process can take about 5 to 7 minutes; so, if you have three patients check in, you can fall 21 minutes behind."
How Grandview optimized provider in triage
Grandview now has a team approach to triage, with a physician and two nurses comprising the provider-in-triage team.
The nursing staff played a key role in launching the provider-in-triage model. "We included the nursing staff and identified a select few who could educate [their peers] and be champions of the process," Funk says.
The select cadre of nurses helped Funk in the early stage of the initiative, which started in July 2017. "I personally worked all of my shifts as the provider in triage to refine the process with selected nursing staff before we brought in the other two physicians who were going to be providers in triage."
Christopher Cheney is the senior clinical care editor at HealthLeaders.