Long waits in the emergency department are a fact of life for many. If patients start leaving without being seen, though, hospitals need to take action. Find out how one ED addressed that problem with an innovative, interprofessional approach to triage at the session “Razzle Dazzle: Your Guide to the ED Rapid Assessment Zone” on Sept. 6 from 12:45-1:15 p.m. in Veronese 2403.
Presenter Suzanne Petit, MSN, RN, will share how the ED at Mercy Health-Fairfield Hospital in Fairfield, Ohio, ED created a fast-track program to reduce the backlogs and bottlenecks, resulting in a significant drop in the number of patients leaving-before treatment.
Suzanne Petit, MSN, RN
A few years ago, during the height of the COVID-19 pandemic, the leave without treatment rate at the Mercy Health ED was up to 6 percent. Struggling with throughput in the ED, the staff had tried many different kinds of triage to help connect providers with patients, according to Petit, ED supervisor at Mercy Health. In a traditional triage scenario, one nurse and perhaps an ED technician would be ready to see patients. If no beds were available, a common occurrence, the nurse would evaluate patients and send them back to the waiting room to be seen by additional providers. When waits became interminable, these patients sometimes simply walked out of the hospital without being treated.
The Mercy Health ED team knew this system was unsustainable. For a time, staffers experimented with having an advanced practice professional or physician provide additional support to the triage nurse. But this approach still meant attending to one patient at a time and also left doctors struggling to get paid by insurers.
Acknowledging that a new triage process was imperative, team members again put their heads together. “We had to figure out a way for us to get as many patients as possible in front of the provider,” Petit said.
Ultimately, Petit and her colleagues hit on a solution that has worked out well for them. They converted their six-bed fast-track area plus their two-bay triage area into an eight-bay rapid assessment zone, or RAZ. This zone is staffed by nurses, APPs and a variety of other providers who provide medical screenings and place orders regardless of bed availability in the main ED.
The RAZ can accommodate eight patients at once and allows for access to multiple testing and assessment options. For instance, patients can receive an EKG right in the RAZ instead of being taken to a separate location. They can have blood drawn on the spot by a phlebotomist rather than wait to be ushered to a separate lab. Multiple providers are in and out of the RAZ all the time, bringing treatment directly to patients.
A big difference from before is that patients now feel seen even if they do end up enduring a wait, according to Petit. For instance, a patient may meet with a provider in the RAZ and be referred for an X-ray or CT scan, which can take a bit of time. If the patient is sent back to the waiting room in the interim, they at least know they are on the schedule and will be having the procedure. They know somebody is aware of them and working to get them assessed and treated.
The numbers speak for themselves: Since the first quarter of 2021, when the RAZ was first up and running, the leave-without-treatment rate has averaged 1 percent or less, Petit said. The latest results from the first quarter of 2024 showed a leave-without-treatment rate of just 0.6 percent.
The RAZ has worked so well that all of Mercy’s sister hospitals in the Cincinnati area have rolled out their own RAZs, and Petit and her team have given talks throughout Ohio to staffers interested in implementing similar initiatives in their own hospitals.