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No-Wait ED Doesn’t Even Have A Waiting Room

October 21, 2011
Written by: , Filed in: Diagnostic Imaging, Emergency Radiology, Practice Management
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A patient shuffles into the emergency department, presenting with a minor injury or vague complaint of pain. The next step would be “please take a seat and wait until we call your name,” right?

Not at the Issaquah Campus of Swedish Medical Center, just east of Seattle. There’s no seat to take, because there’s no waiting room. Nor is there a wait.

Instead, front-desk staffers take each emergency patient to a treatment room. There, says John Milne, MD, vice president of medical affairs at Swedish Medical Center, a team converges on the patient like a pit crew servicing a race car.

As a technician takes blood pressure and other vital signs, a physician evaluates the patient’s condition and provides any necessary care. A primary nurse tracks the patient throughout his or her ED stay. Said Dr. Milne:

Interventions, when needed, are immediately provided, not triaged. Within the first 15 minutes, X-rays are ordered, labs are ordered, the patient is seen by the physician, and care has been initiated.

Dr. Milne was quoted in an article in Becker’s Hospital Review. Swedish Medical Center has been using streamlined procedures in a freestanding Issaquah ED since 2005. It’s now building an entire Issaquah campus. The new ED and some other facilities opened in July. The main hospital is scheduled to open November 1.

Perhaps the key person is the charge nurse, who monitors the entire ED, taking a quick look at each arriving patient and ensuring that exam rooms are open. Dr. Milne said Swedish-Issaquah has fulfilled its no-wait promise “99.9 percent” of the time, though sometimes the charge nurse may move a patient to a discharge holding area (sort of a post-waiting room) for completion of treatment to free a room for a new patient.

Dr. Milne, an ED physician, said he juggles his time for greater efficiency. For a complex case, he orders imaging or lab tests. While waiting for those results, he tends to patients with sprains or other simple ailments. Only when he gets the test and scan results does he return to the complex case to take a complete history and perform a physical exam. He explained:

Complex patients can take a lot of time and need me to really dedicate my attention to them. Unless they are unstable for some reason, that sicker patient is going to be there for a little while. My goal is not to let the simple cases back up.

This year, the Issaquah ED won its third straight Press Ganey Summit Award for sustained patient satisfaction. It also scored highly on such safety measures as antibiotic start time and EKG orders.

For the system to work, Dr. Milne said, “There has to be true buy-in from staff and physicians.” Given the current pressures on health care, staff and physicians across the country may, like it or not, have to become buyers.

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Related seminar: Emergency Radiology


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One Response to “No-Wait ED Doesn’t Even Have A Waiting Room”

  1. Designing a “no wait” emergency department « American Hospital Association Resource Center Blog on October 21st, 2011 at 3:36 pm

    […] Millburg, S. No-wait ED doesn’t even have a waiting room. Radiology Daily. October 21, 2011. http://www.radiologydaily.com/daily/diagnostic-imaging/no-wait-ed-doesnt-even-have-a-waiting-room/ […]