Amidst reports that Maryland
had some of the longest
Emergency Department (ED)
wait times in the nation,
CalvertHealth piloted a new
process aimed at reducing wait
times, expediting patient flow
and freeing up beds needed
for higher acuity patients.
And early results show a huge
improvement.
The ED team saw an 89%
reduction in the number of
patients who left without being
seen and a 68% reduction in
the amount of time patients
waited to see a provider.
“We had to reimagine the way we
provide care. Your next visit to the
ED will not look the same as a visit
last year, or even just a few months
ago,” said emergency medicine
physician Stephanie Dabulis, MD.
Emergency departments have been
forced to think outside of the box
to provide the best emergency care
to everyone safely and responsibly.
“Our goal was to treat a growing
number of patients in the same
space, while providing safe, highquality
patient care. It was a tall
order, but we knew we had to do
something, and our team was up for
the challenge.”
To combat overcrowding and the
increasing demand for health care,
the ED team ultimately decided to
implement a “split-flow” process.
Utilizing the new process, a team of
clinicians – to include a physician
or advanced practice professional
(physician assistant or certified
registered nurse practitioner) –
triages the patient soon after their
arrival and then puts the individual
on one of two tracks depending
on the severity of the injury or
illness. “As an emergency medicine
physician, the opportunity to
evaluate our patients as quickly as
possible after arrival is invaluable.
And in some cases, lifesaving,” said
Dr. Dabulis.
Patients with less severe
conditions who are stable may
be kept in specifically designated
waiting areas to await test results
or medical images. Those diagnosed
with more serious injuries or
illnesses may be placed in a room with a bed for further assessment
and treatment. Dr. Dabulis says, “The
process accelerates the treatment and
discharge of patients with less severe
complaints and speeds up treatment
and hospital admission for those
requiring additional care.”
Recent ED patient Joanna Yakaitis
was amazed by the difference.
“In December I was advised by
my physician to go to the ED for a
critical test. My patient experience
was less than what I expected from
CalvertHealth.” Yakaitis cited the
triage process and the length of
time it took her to be seen as two of
the largest obstacles to care. Just a
few months later, Yakaitis had the
opportunity to observe the new process
to see the changes for herself. “The
improvements to the facility and
the process, especially as it relates
to triage, is greatly improved and
will certainly enhance the patient
experience.” She applauded leadership
for their willingness to listen to the
community’s concerns and taking
action to execute improvements.
Emergency Department ROADMAP
STEP 1: Arrival (Walk-in or EMS)
Once you arrive, you will sign in at
registration and then have a seat. A
nurse will call you to the new triage
area for a private evaluation. If arriving
by EMS, a quick assessment will be
performed, and you will be directed
to the appropriate care based on the
severity of your illness or injury.
STEP 2: Triage
Your health condition will be
checked during your evaluation through
a process called triage. This evaluation
helps the ED team determine which
patients are to be treated first. A patient
whose condition is life-threatening
will be top priority. Often blood tests,
medical imaging and other studies are
ordered and possibly drawn at this time
to help your ED provider diagnose your
condition quickly and accurately. Once
your evaluation is completed, the next
step will be to wait for a “bed” or “chair”
assignment.
Step 3: Patient Care Assignments
Once you have been evaluated, you
will be assigned to a bed or chair in the
appropriate care area for your condition
and treatment. Not every patient
receives a traditional ER bed. Patients
who are stable with less severe conditions
may be asked to wait for test results in
specifically designated waiting areas.
STEP 4: Your Care
Once your treatment has begun,
the length of time you are at the ED will
vary depending on your condition and
the number of patients in the ED at the
time. Your provider or nurse may order
tests, including blood work and X-rays
that can take from one to four hours to
process. Your provider may also order
additional tests after receiving the first
set of results. Your care team will explain
the tests they are performing, their
plan for your treatment, answer any of
your health questions and check on any
changes in your condition.
ED providers and other team members
will give you immediate treatment based
on your condition and test results. Please
note - if medical imaging tests such as
CT scans or X-rays have been performed,
a radiologist will be asked to provide
input on your treatment.
STEP 5: Your Next Steps
If you need to be admitted
to the hospital: Before you can be
admitted, hospital staff will need to
identify a room for you and ensure
the room and staff are ready for you.
The time it takes to receive a hospital
room is based on the hospital’s census,
which is the total number of patients in
the hospital. It also takes time to clean
and prepare rooms for new patients.
If you need to be transferred: If your
condition requires us to transfer you
to another care facility, your care
team will contact the facility to see
if there is a room and a physician
on staff available to accept a new
patient. Then, we will arrange your
transportation. This process may
take several hours, but your care will
continue. If your condition is critical,
the transfer process will be faster.
If you are ready to be discharged
home: The ED provider will let you
know what they have learned from your
exam and diagnostic tests. If your lab
results are not available at the time of
your discharge, you might not receive a
final diagnosis. We will refer you to the
proper place for follow-up care —
usually with your primary care
physician or a specialist, depending on
your condition. Medications and care
at home will be explained. Please ask
questions if you are unsure about the
instructions you receive.
The “Split-Flow” Model
What’s in it for You?
- Increases patient safety as a result of shorter door-to-provider time
- Expedites patient flow and frees up beds needed for higher acuity patients
- Relieves frustration due to bottlenecking when patient volumes are high
- Decreases the number of patients who leave without being seen
- Increases patient satisfaction due to shorter wait times
- Improves the patient experience
EMERGENCY DEPARTMENT MYTHS: DEBUNKED
MYTH 1: Patients are seen in the order they arrive. Care in an emergency setting
is prioritized by severity of condition, meaning the sickest patients will be seen first -
regardless of arrival time, check-in time or wait time.
MYTH 2: You will be seen faster if you arrive by ambulance. Arriving by
ambulance does not mean you will have a shorter time for care in the ED. All patients
are assessed upon arrival and prioritized according to their condition. Remember:
If you are experiencing a true emergency, you should always call 911 as Emergency
Medical Services (EMS) can begin providing care while en route and call ahead to let
the ER staff know a critical patient is on the way.
MYTH 3: You will always be seen by a doctor. In addition to physicians (MD or
DO), advance practice professionals such as physician assistants (PA) and certified
registered nurse practitioners (CRNP) are also trained to order and interpret diagnostic
and laboratory tests, diagnose disease, prescribe medications and create treatment
plans. Any patient request to be seen by a medical doctor will be granted.