A group of 200 emergency department leaders (medical directors, nurse managers, and executives) met Feb. 24–26 in Orlando for the Innovations in ED Management 2015 conference. This annual conference, now in its 15th year, is a collaboration between the Emergency Department Benchmarking Alliance (EDBA), a nonprofit organization that collects and shares performance data and operational information among its nearly 2,000 hospital members, The Center for Medical Education, and The Center for Emergency Medical Education. Emergency medicine thought leaders presented information on the problems and solutions facing our specialty. One of the highlights was the poster competition where doctors and nurses shared their performance-improvement stories.

Patients were evaluated initially in the old closet, now a proper intake space.

One such poster submission came from Bon Secours Maryview Medical Center, an emergency department in Portsmouth, Virginia, which treats 40,000 visits in a 21-bed unit with a seven-bed fast track. Unhappy with its metrics, the department looked at strategies to reduce its door-to-provider times and left without being seen (LWBS) rates and to improve both patient and staff satisfaction. Many of the national physician groups like TeamHealth, EMP, and CEP have been trialing the Provider in Triage (PIT) process around the country with growing success. The leadership at Maryview decided to trial this process, whereby the provider encounter would be moved to the front of an ED visit.

An old closet near the traditional triage area was identified as the perfect footprint for a PIT model. A leadership team, which consisted of Daniel Salomonsky, DO, Kip Wenger, DO, Andrea Lanier, RN, Beth King, RN, and Kathleen Grzeskiewicz, RN, went to work to redesign the intake process and the space to accommodate the new changes. After months of planning, construction, and staff training, the PIT process was rolled out in April 2014. Kudos to the leadership team because all too often new processes fail at implementation. Their success suggests that the rollout was impeccable.

Patients were evaluated initially in the old closet, now a proper intake space. Many patients could be dispositioned from this area without ever going to a patient room. The patients with time-critical conditions were seen by a provider and expedited to a room in the main ED. The measurements speak to their wonderful results.

Their success was immediately noted by the community and patient daily census, which had been stable at 115 patients per day for many years and jumped to 128 patients per day!

Would something like this work in your shop? Take a critical look at your facility. Can you hijack some space in the current footprint that, at minimal cost to the institution, will allow a revamping of your intake process and patient flow? When the Maryview leadership invited the community to “come into the closet,” great things happened.