Emergency department divided into teams, zones

New receiving processes, a new team structure, and zone divisions in the ED at Cape Fear Valley Medical Center in Fayetteville, NC, have enabled the hospital to cut triage time in half, according to Linda K. Dietterich, RN, MS, CEN, CAN, service line director for the ED.

"In the past, the ED was divided according to specialization by patient complaint, such as chest pain," Dietterich says. "Now, the ED is divided into zones, with equal distribution of beds, which provides treatment for any incoming patient complaint in every zone."

Each zone, which consists of eight to 11 beds, is assigned a team that provides overall care of the patients within that zone, she continues. Each team consists of an ED physician, RN team leader, ED staff nurses, ED technicians, paramedic, unit secretary, and patient access representative.

The RN team leader monitors and maintains patient flow within the zone, provides updates to the ED lead charge nurse regularly to ensure early initiation of backup when needed, and provides notification of pending admissions and discharges within the zone. This communication provides the ED lead charge nurse with bed availability, which facilitates bed assignments for new arrivals, says Dietterich. The zone staff nurse assignment is based on patient acuity, with the goal of nurse-to-patient ratio being 1:4.

The ED technicians/paramedics assist the ED provider and staff nurse with bedside treatments. The zone access representative completes patient registration activities at the bedside.