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" No patient in waiting Room Policy"
Sounds interesting. This is perhaps, part of the patient satisfaction interest 
of all hospital administration.
To me this is good and may avoid missing a really sick patient.
How practical this is, is the question.
Today there is a bottle neck in ER as patients, admitted also do not get to the 
floor quickly.
Just saw an email regarding admitted patient held in our adult ED due to in 
patient bed being not available.
Also, since it is not made easy, for lot of complains, to be worked up as 
outpatient ,ER is  being used as an easy and quick way by patients as well as 
PMDs to get work up,get consults etc, as a result patients who really can go 
home end up being in ER longer. MSE  taken to even getting MRI. ( A diagnostic 
center suggested to me by a smart APN sounds like  a good plan, already being 
done for adults).
Any way hope we all put our minds together and make the ER a more smooth 
highway!!!
My 2 cents
Radhika Vijayan
HUMC

 





What lies behind us and what lies before us are tiny matters compared to what 
lies within us.
                                                                                 
      -Emerson-





________________________________
From: rick place <[log in to unmask]>
To: [log in to unmask]
Sent: Fri, January 14, 2011 11:38:19 AM
Subject: Re: Pediatric triage

We have been hovering with a volume around 30,000 for the past two years and
for the past year have essentially been direct bedding with rare exceptions.
We have not had up front triage for months (although we have recently placed
a "first look" nurse during peak hours to facilitate intake and this nurse
does a true quick-look triage, not a traditional one).

To the extent possible, we have tried to create a culture where physicians
and nurses will frequently be available as the patient hits the room and
there will be a combined assessment (of sorts). Minimizes nonproductive wait
times up front, minimizes repeating the story, and focuses on why the
patient has come....to see the physician.

It is not perfect and has created morale issues as triage is closely linked
to nursing self esteem. Furthermore, when four patients come back
simultaneously (without a serial triage) there is pressure to see them
quickly. It is much more of a push system than a pull system, which is part
of its effectiveness and also part of the tension it creates.

I have expended a significant amount of my administrative capital on this
and there are a number of unhappy staff in this regard. I am not a big fan
of the concept of triage in its traditional sense if you can eliminate the
need for it. I recognize the concept of "nursing assessment" which is part
regulatory, part triage and an ongoing, rather than one time event.

The door to doc times are dramatically lower than in the past, the work ups
begin earlier and the downstream effects are clear.

Lest I sound too rosy, this has not been (and is not currently now) a
frictionless process. But conceptually it is sound and in the patient's best
interest. So if you can, forge ahead.

Rick

Rick Place, MD
Department of Emergency Medicine
Inova Fairfax Hospital for Children
3300 Gallows Road
Falls Church, VA 22042

On Thu, Jan 13, 2011 at 12:08 PM, Christopher Kelly <[log in to unmask]>wrote:

> Question for the group.  We are a growing community hospital in Brooklyn
> serving about 20,000 Peds er visits a year.  We recently have switched to a
> no waiting room policy in which all kids are brought back immediately upon
> arrival and triaged within the ER.  This puts a lot of strain on our one
> nurse so we are contemplating going to a pnp/physician driven triage and
> treat for our less sick patients, basically eliminating the need for a nurse
> for your run of the mill cases.  Anybody using such a model and have any
> tips as to streamline the process?  Does anyone know of absolute required
> fields that need to be included in the triage process?  We are trying to
> eliminate questions which appear to be directed more towards adults (I.e.
> Domestic violence, suicide) as i do not believe they are mandated for every
> pediatric triage. Any help would be appreciated.
>
> Christopher Kelly
> Medical Director
> Pediatric Emergency Medicine
> New York Methodist Hospital
> Brooklyn, NY
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                http://listserv.brown.edu/ped-em-l.html
>



-- 
Rick Place, MD
Department of Emergency Medicine
Inova Fairfax Hospital for Children
3300 Gallows Road
Falls Church, VA 22042

For more information, send mail to [log in to unmask] with the message: 
info PED-EM-L
The URL for the PED-EM-L Web Page is:
                http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html