SPEED (Serving Patients Efficiently in the Emergency Department): Improvement in ED flow from an emergency physician at the initial point of contact
Authors: Frank Illuzzi, MD**, Ryan King, BSEE*, Melanie Dabakis, BS*, Ankur Talati, BS*, Jenna Turocy, BS*, Keith Bradley, MD* Ann Emerg Med 58 S295-296
Objectives: To determine the accuracy and time intervals of care from a system change in assigning an emergency physician as Rapid Assessment Physician (RAP) with nurses and emergency techs as a Rapid Assessment Team to the Rapid Assessment Area (RAA)/triage.
Methods: Design prospective, observational. setting: urban, community hospital. participants: Rapid Assessment Team in the RAA. During their 4-hour shifts, Research Associates (RAs), pre-health professional volunteer data collectors, stood by the side of the RAP recording the times and dispositions from initial contact to dispositions based on anticipated use of resources: Main ED (> 1h, potential for admission), Express Care (about 1h, > 1-2 test, low-moderate potential for admission), Brief Testing (< 1 hour, 1-2 test, admission unlikely), discharge without testing. Times for other elements out of sight of the RA were recorded from standard electronic documentation on computers with times synchronized with the study computers.
Results: Over 135 shifts in 10 weeks, 25 RAs observed 6 EPs’ interactions with 1571 patients in the RAA. From triage, 272 (17 %) were sent to the main ED, 217 (14 %) to Express Care, 694 (44 %) discharge from triage, 385 (25 %) Brief Testing. Thus, 69% of patients presenting to the RAA were seen and discharged by the RAP. There were 59 (4%) admissions from the RAA. This was 12% of those sent from the RAA to the main ED/Express Care. All admitted patients were identified by the RAP as needing more intensive work-up than could be accomplished in the RAA.
Conclusion: A Rapid Assessment Team can efficiently assess, treat and release the majority of patients presenting for triage. Emergency physicians in a RAA make accurate and very rapid disposition decisions. Testing beyond history and physical examination introduced delays in decision making without adding to the disposition decision. Non-physician personnel contributed to most of the time needed to discharge triage patients who are going home from the ED.
