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Emergency Department Changes

Reduces Wait, Visit Times

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


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.

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