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ER triage program speeds admissions


Part of the University of Chicago Medical Center.

An experimental emergency room triage program that coordinated care with multiple departments at the University of Chicago Medical Center  cut wait times for very ill patients to be admitted to the hospital by more than two hours.

study in the Annals of Emergency Medicine looked at how  clinicians in the program apparently achieved this.

University of Chicago Medical Center researchers designed the pilot, called “Dr. Admit,” to help physicians identify as early  as possible the sickest patients showing up in the ER. They then worked closely with nurses, the laboratory, imaging and consulting resources to prioritize the patients’ needs.

Patients in the  program were admitted within 192 minutes after arrival in the ER compared to the other patients, who were admitted on average 329 minutes after arrival.

To read the report, please hit this link.



How Colo. hospital reinvented its ED


University of Colorado Hospital, in Aurora.


The University 0f Colorado Hospital reinvented its emergency department to cut wait times and costs, writes Richard Zane, M.D., who runs the department.
While some hospitals have seen the challenge as making small emergency rooms big ones, Dr. Zane, in the Harvard Business Review, noted that:

“Instead of being small, crowded and dysfunctional, many EDs are now big, crowded and dysfunctional. That’s not progress.”

So, his article says, his hospital created groups of 8-10 providers to quickly study quality, operations and process improvement. A nurse and a physician led two of the three groups, and an engineer, a nurse and a physician led the process-improvement group. Members rotated among the subcommittees.

The groups decided to:

  • Improve the patient experience by eliminating triage and having a senior physician see each patient within minutes of  a patient’s arrival.
  •  The hospital moved the ED observation unit when it became clear the location didn’t work, and moved portable X-ray machines to certain non-critical patients rather than moving them to the machines.
  • Develop  care pathways for high-risk presentations, including heart attack, stroke and sepsis, or those associated with significant practice variability, such as chest, abdominal and back pain. Thus  the ED was able to cut high-cost imagery costs by 15 percent and avoidable hospital admissions by 20 percent.

Using ‘lean’ techniques to slash ER waits


An article in Healthcare Informatics reports on how Kaiser Permanente South Sacramento, one of California’s busiest emergency departments, slashed patient-wait times to far below the national average thanks to adopting the sort of ”lean” processes used in manufacturing.

Kaiser South Sacramento’s average wait time is only 19 minutes, less than half the national average of 58 minutes. Length of stay is also down to 43 minutes for low-acuity patients, compared to the 118-minute national average.

To help achieve this, Kaiser  streamlined its extensive triage process, cut its screening exam from 19 minutes to two minutes, and now has physician-nurse teams control patient flow.



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