Dr. Laura Forman is the physician-in-chief of emergency medicine at Memorial Hospital, which recently streamlined its emergency department admissions process and cut wait times in half, from an average more than 40 minutes before the changes to 20 minutes as of today. Forman earned her medical degree from the University of Vermont College of Medicine and completed her emergency medicine residency at Baystate Medical Center through Tufts University School of Medicine, serving as chief resident in her final year. She is a clinical instructor in emergency medicine at The Warren Alpert Medical School of Brown University.
PBN: Is the new intake booth performing a different kind of triage than used to be performed at Memorial? Or is merely using your physical space differently streamlining the process?
FORMAN: Yes, this is a streamlined triage process which is much quicker than the prior model. The old triage model involved an extensive triage done by a single nurse for every patient upon arrival in the emergency deparatment. This created a bottleneck, as every arriving patient waited for the triage nurse to become available. Now the triage upon arrival to the emergency department is brief, and the majority of the triage is actually done at the bedside, by the patient’s primary nurse. This allows both faster entry to the emergency department and, decreases the transitions in care, as the nurse who does the triage is also the patient’s primary nurse.
PBN: Does the fact that fewer people linger in the waiting area have knock-on benefits, for instance less potential transmission of viruses among those waiting?
FORMAN: Yes, there is less potential transmission, and greater privacy for patients as they are in a single room, as opposed to a full waiting room.
PBN: Does the more streamlined emergency department processing protocol require either more or less staffing – or is there no effect on that?
FORMAN: It requires slightly more staffing than the old model.
PBN: What were the most important lessons and findings from Kent Hospital’s adoption of the same model in 2010?
FORMAN: Members of the Memorial emergency department staff spent time in the Kent emergency department while Memorial was preparing for this transition. Our staff were able to observe Kent’s emergency staff in action, and better understand how to fine-tune the model for our use. Both the Memorial emergency department nurse manager and physician-in-chief had previously worked at Kent, and were able to take their knowledge of Kent’s processes and apply it to Memorial’s physical space and processes. The lessons from Kent helped to predict what issues might arise at Memorial, and allowed for better planning and proactive solutions.
PBN: Does the diminished wait time for patients lower the level of stress in the emergency department, with patients and families seeing faster progress than was formerly the case?
FORMAN: It is less stressful for patients and families to have less waiting time, and to be seen sooner by a physician.
