'No-wait' ED a five-year success

Wait time to see practitioner cut in half

A true test of the success of a process improvement initiative is whether the results can be sustained, and the ED at Hudson Valley Hospital Center in Cortlandt Manor, NY, has just celebrated the fifth anniversary of its "no wait" process. Most patients skip the waiting room entirely and go right to registration, and then to triage.

"We've cut the wait time to be seen by a practitioner by 50%," says Ron Nutovits, MD, FAAEM, chair of the ED. "Most patients are now triaged within five minutes and seen by a practitioner within 20. Within the first month, our rate of patients who left without being seen went from .7% to .33%, and our Press Ganey scores went to the mid-90s." Nuvovits says the 35,000-visit ED was also recognized by Press Ganey for its high staff satisfaction scores.

Maryanne Maffei, RN, MS, director of nursing, explains the process. "When the patient comes in, they sign in at the registration desk. We do a quick registration — name and date of birth — so we can give them a medical record number, and then they have a seat. Their name then appears on our computerized system, and the triage nurse takes them from the waiting room to the triage room." When triage is finished, the patient is taken immediately into the care area, where labs and X-rays can be ordered and treatment begun, Maffei says.

Nuvovits says, "It became a one-way system. Instead of coming in, registering, and going back to the waiting room, now they come in and the greeter gets them into our tracking system, alerts the triage nurse; they go to triage and come directly from triage to the main ED." The department has two triage areas, so patients can be treated simultaneously, he adds.

Maffei says, "We really focused on triage in training. If more than two people are in the waiting room, the staff will go there, bring them to a room, and triage them."

It was emphasized to staff that this change would benefit patient safety. "We needed to change the thought process of some of the nurses in the department, so they could see how much safer it was going to be to bring patients immediately into the department for treatment," says Maffei.

Eventually, this approach became "part of the norm," she says. In fact, Maffei shares, there's another hospital nearby that is trying to implement a similar approach. "They were discussing it with one of our nurses, and she told them, 'Don't worry, it's hard at the beginning, but you get used to it,'" she says. (The transition was also made easier through the use of simulations, which helped ensure that staffing levels matched demand fluctuation.)

[For more information on reducing wait times, contact:

Maryanne Maffei, RN, MS, Director of Nursing, Ron Nutovits, MD, FAAEM, Chairman of the ED, Hudson Valley Hospital Center, Cortlandt Manor, NY. Phone: (914) 734-3247.]