Like many EDs across the country, the ED at Lakewood Regional Medical Center (LRMC) in Lakewood, CA, struggles with wait times.
“We are a small community hospital that sees an average of 150 patients a day through our ED. We stay busy because the ED is usually a patient’s first access to healthcare,” explains Patty Stierle, RN, BSN, interim director of the ED and disaster coordinator at LRMC.
However, some patients are coming to the ED from nearby urgent care centers and physician offices where their care has already begun. ED administrators saw in this group a new opportunity to reduce wait times while also promoting better care integration between different healthcare settings.
Consequently, they developed a red “fast pass” card specifically designed to streamline the process for these patients when they present to the ED.
A provider at an urgent care center or physician’s office who is referring a patient to the ED will first call the ED and discuss the need for a transfer of care with an emergency physician. Then, the referring physician will provide the patient with a fast pass card, along with any other important information about the patient’s condition and medical care.
When the patient arrives in the ED, he or she will hand the fast pass card to the registrar to begin the process of moving that patient into the ED quickly.
“Our staff members know that this patient has been seen prior to arriving [in the ED] and is coming to us for additional care,” Stierle explains. “If the patient is coming to us from an urgent care facility and has this card, we know that initial care has been started.”
The fast pass card includes “Lakewood Regional Medical Center Emergency Room” written on the front. “The patient will also come in with any other results or reports that the referring agency is sending,” Stierle says.
She adds that the back of the card includes space where the referring provider will write their name and location. This makes it clear where the patient has just been seen. “The fast pass card also has a note that reads ‘Although fast pass patients are a priority, please understand that patients with life threatening conditions will be seen first,’” Stierle explains.
The approach has been designed, in part, to promote good communication between different healthcare entities that are located within 10 miles of LRMC, particularly given that a number of new urgent care facilities have been built in the area surrounding the hospital in recent years. “Noticing and differentiating patients based on acuity ultimately will help speed up any ED process,” Stierle observes.
In fact, the idea came about as a result of hospital outreach to many of the physician offices and urgent care facilities in the area. They expressed the need for a more streamlined process for moving patients into the care area, Stierle relates.
Then, the ED throughput committee at LRMC, which includes members of the hospital administrative team, physicians, and business development staff, engaged in a collaborative process to design a new approach for those patients coming to the ED from another setting. At those other facilities, patients may have received some form of workup such as X-rays, lab work, or other clinical care.
Once the throughput committee designed the fast pass process, they ran it by the outpatient providers for additional input prior to implementation.
Stierle notes that in recent years, EDs have moved away from a linear process where patients first see a provider and then undergo testing and labs to one where many of these steps occur simultaneously in more of a multitiered approach.
“This is the next step in that process, to streamline what we can for patients who are coming into the ED,” she says. “We are starting with the identification process for our referring providers. When a person walks in with a fast pass card, it tells us that this patient has already been seen at an urgent care facility [or a physician’s office] nearby, and we are going to continue their care.” While data regarding any effect on wait times are not available yet, early indications are that the fast pass approach is earning high marks from stakeholders involved, according to Stierle.
“The patients feel that they have a team for their healthcare,” she says.
Further, she notes the referring providers are pleased with the approach, too. Stierle notes that the different healthcare providers always should work in concert with one another. “It elevates care for the community,” she adds.
Other EDs interested in pursuing a similar approach must understand that there are many steps involved with developing and implementing a successful process, Stierle cautions.
“Our business department at LRMC did the legwork of reaching out to our neighboring urgent care facilities [to explain] the process. We also then had to educate our ED staff in identifying and noticing patients who walk in with the red fast pass cards,” she explains. “Ultimately, implementing the process takes time, but it is a great benefit because we have to work as a team across different organizations.”
Stierle adds that when professionals talk peer to peer about specific cases, it helps improve the provider knowledge base.