Lab work and other testing is crucial in realizing the potential for efficiency gains from the provider-in-triage model.
"We are utilizing the time it takes to get a radiological study or get lab tests done during the time that patients are waiting to see a provider," Funk says.
However, Grandview had to innovate to overcome a challenge associated with testing under the provider-in-triage model.
"Most times, it is the low-acuity patients who get tired of waiting. Even though they may have had labs drawn or radiological tests done, they were sent to a waiting room, and sometimes they leave from there," says Dawn Sweet, clinical nurse manager at the 344-bed hospital.
'Results-pending' waiting room
Grandview's solution was to create a special waiting area for patients awaiting test results.
"We keep patients in the department. We have a results-pending area now; so, our low-acuity patients have their tests completed, go to our results-pending area, and can be discharged from there," Sweet says.
Data reflect patient satisfaction with the provider-in-triage approach at Grandview:
- Before provider in triage: 1.8%–2.2% left-without-being-seen rate
- After provider in triage: 1.1% left-without-being-seen rate
- Patients leaving against medical advice have also fallen, with that rate running at about 1%
"With other institutions that have trialed this process, the left-without-being-seen rate has gone down but the against-medical-advice rate has gone up. That has not been true for us. With our facility, both numbers went down," Sweet says.
"With our process, we have been able to retain nearly all of our patients through the full length of their care. They are not waiting as long for tests and results," she says.
Benefits of provider-in-triage model
Grandview is generating clinical, financial, and strategic benefits from adoption of provider in triage.
In an emergency department, more efficient use of time can save lives and alleviate needless suffering, Funk says. "There have been multiple instances across the country of critical patients waiting in an emergency department waiting room."
Christopher Cheney is the senior clinical care editor at HealthLeaders.