I found it somewhat difficult to empathize with Perth Amboy’s ED dilemma (227 minutes discharge average, 3.2 percent LWBS) in a 36-bed ED with 17 percent admits and a 47,000 annual census [“Split for Success,” Nov. 2016]. My ED (St. Francis Hospital in Federal Way, Washington) will see 55,000 patients, with 16 percent admits and transfers in 2015, with 3 percent LWBS and a 150-minute median for discharged patients—in a 24-bed ED.

The Perth Amboy ED has a very high low-acuity population (40 percent triage level 4 and 5) and would’ve probably been better served by developing a supertrack segmentation for these lowest-acuity patients.

–Jeffrey M. Cortazzo, MD, FACEP
Federal Way, Washington

Dr. Welch Responds

Dear Dr. Cortazzo,

It sounds like you work in a very efficient shop! Perth Amboy on the other hand was struggling ….

You are right—there were many options for them to consider that would improve workflow and patient flow. I might have put a provider in triage and employed vertical patient flow, for example. That said, ESI 3 patients dominate in every emergency department, and the management of this heterogeneous and diverse group of patients is becoming a universal challenge in emergency medicine.

That is why their story was attractive to me and, in my view, worth telling. It has widespread applicability and transferability to many other EDs and addresses a universal problem. It may provide a starting point for other EDs trying to manage the tidal wave of ESI 3 patients.

Hey, they did cut their door-to-physician time dramatically with the new model. Doesn’t that earn them some kudos?

Thanks for your comments!

–Shari Welch, MD, FACEP
Salt Lake City