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Speed it up: Two programs help reduce length of stay for emergency-room visitors

Those of you who have ever waited for hours (or what feels like hours) in an emergency room might appreciate this statistic: In the last eight months, the median door-to-doctor time for patients visiting Stanford's emergency department dropped from 45 minutes to 18. So what happened? Credit the implementation of two new programs, Team Triage and Fast Track, that were "designed to provide speedier, more efficient service" in the ED. The current issue of Stanford Medicine News has more details:

First came Team Triage, inaugurated a year ago. In the same area as the waiting room, big bronze-colored letters that spell “triage nurse” are affixed to a dividing wall, behind which patients are evaluated by a team of doctors, nurses and ED technicians. Apart from trauma patients brought in by ambulance to receive the highest-priority care, everyone who comes into the ED passes through the Team Triage area. Minor injuries are classified as 4 or 5, the most critical as 1. “Most patients are 3s,” said Patrice Callagy, RN, patient care manager in the ED. “They might have abdominal pain or broken bones.” Team Triage also allows for earlier diagnosis of time-sensitive conditions, such as stroke.

An analysis found that 40 percent of the hospital’s patients were sick enough to have been admitted through the ED. It also showed that 12 to 13 percent of the ED’s patients were 4s and 5s, who did not require hospitalization. Yet their relatively minor medical issues meant that they were waiting the longest, starting with how long it took for them to see a doctor.


Enter Fast Track, a dedicated team composed of doctors, nurses and ED technicians whose job is to treat patients with less-severe health problems as rapidly as possible. “We treat you and let you get on with your life,” said [Grant Lipman, MD], Fast Track’s medical director. “You’re the least sick, so we’ll treat you the fastest.” The median length of stay for Fast Track patients is 65 minutes, well under the original goal of 90 minutes.

Previously: Decreasing demand on emergency department resources with “ankle hotline” and Windows ER?

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