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Increased admission rates to BWH’s Emergency Department (ED) have sparked the need for changes to best serve each patient. In October 2002, a team of physicians implemented the “Rapid Assessment Team” aimed at decreasing wait time and length of stay in the department, while decompressing the ED. Likewise, an improved Triage System has further improved categorizing ED patients to make sure they efficiently receive appropriate and timely care.
From 12 to 8 p.m., the Rapid Assessment Team, consisting of an attending Emergency Services physician and a nurse, help to expedite less acute patient cases in the Observation Unit, facilitating quicker and more efficient care. According to Nurse Educator Nicki Gilboy, the team’s impact on patient flow in the ED has been substantial.
Such success is evident in this quarter’s Press Ganey results. “We have decreased waiting time for all patients,” said Gilboy, who explained that ESI (the ED’s acuity rating system) is used to identify those patients appropriate for care by the Rapid Assessment Team. Once these patients are identified, they are taken out of the patient load of those needing more acute care; therefore, freeing up beds and lessening wait times for the general ED patient population.
In conjunction with the Rapid Assessment Team, the ED’s Triage System—a five level method that enables the staff to determine more accurately those patients that require immediate and urgent care—has improved care. The system was implemented several years ago after a major multi-center research study confirmed its reliability.
“Our main goal of triage is to identify those patients with life threatening problems and care for them as soon as possible,” said Jean Mansfield, RN, Emergency Medicine. “This new system has helped us identify the acutely ill patients and move them through the system more quickly, while eliminating some of the nursing variability in triage, making the triage process smoother.”