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Stephan McDonald, MSN, nurse manager of the emergency department,
checks the track board featuring up-to-the-minute patient status information.
KYLE KIELINSKI/thanks to Thomas Jefferson University Hospital
TEAM: Emergency
Department
ENTRY SUBMITTED BY:
Stephan McDonald, MSN,
manager of the emergency
department
such radical change,” McDonald acknowledged. “We set our own
path and looked at best practices across the country.”
McDonald cited the emergency department at University of
Colorado, which he and other staff members visited to prepare for
ED 2.0, as a model for effectively moving patients through an ED.
Prior to the kickoff of the initiative, the department staff held
countless meetings. A conference room was turned into de facto
office space, where anyone interested could learn about the processes
and provide input. As the primary front-line patient care
staff, nurses’ opinions were highly considered. “We wanted to
leverage the amazing nursing staff and we really worked hard
to engage them throughout the process,” McDonald explained.
Improving Patient Flow
The first sign that something is different at TJUH’s ED is the
absence of traditional nurse triage. When an ambulatory patient
first comes in, he or she checks in with the registrar and “Pivot
RN,” who does a cursory triage based on appearance and chief
complaint. “The Pivot Nurse has algorithms to follow,” explained
Susan Cissone, MSN, administrative supervisor in the emergency
department. Those algorithms determine if the patient gets an ED
bed immediately or goes to the intake area.
Four intake rooms are staffed with a physician, a scribe, a vitals
tech and mover techs. After vital signs are taken, the physician
performs a 5-minute assessment. This determines if the patient
will be discharged, moved to the Fast-Track ED (staffed by a physician
assistant or nurse practitioner) or moved to the main ED for
further treatment.
“The goal is anyone who will stay in the emergency department
less than 2 hours goes to Fast Track,” Cissone said. Patients with
low acuity or minor injuries are sent there. Staff members wear
headsets to facilitate communication with one another.
The main ED houses intake, two trauma bays, the A/B areas with
patient beds, and one unexpected feature. “We have our own OR in
the ED. Very few Level I trauma centers have that,” McDonald said.
While the preference is to transfer patients to the operating rooms in
the main hospital, he said, “If you’re hemodynamically unstable with
penetrating trauma, the ED and trauma team can take the patient
directly to our ED OR and attempt to resuscitate the patient and
perform lifesaving surgery immediately.” The ED OR is for the most
critical trauma cases; it is typically used less than 20 times per year.
Less Waiting Means Happier Patients
With ED 2.0 and the new intake model, Jefferson has pretty much
eliminated the external waiting room. An internal waiting area
is opened when the ED is at capacity. With the physician intake
model, patients are typically evaluated by a physician before waiting
in the internal waiting room. To ensure that patients in the
internal waiting area are well cared for and informed, they staff
the area with a nurse and technician. “Your wait time should be
as productive as possible,” Cissone explained.
Located strategically throughout the department are real-time
dashboards designed by TJUH’s IS&T application development team;
these provide up-to-the minute data on a number of key performance
www.advanceweb.com/Nurses n MAY 2016 n ADVANCE FOR NURSES 11