June 8, 2007

Emergency Department lands achievement award

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Emergency Department lands achievement award

Michelle Schierling, M.D., evaluates Ashley Brinsko during triage in Vanderbilt’s Emergency Department as Ashley’s sister, Alexis, and mother, Vicki, look on.
(photo by Susan Urmy)

Michelle Schierling, M.D., evaluates Ashley Brinsko during triage in Vanderbilt’s Emergency Department as Ashley’s sister, Alexis, and mother, Vicki, look on.
(photo by Susan Urmy)

Vanderbilt University Hospital's Emergency Department has won a 2007 National Achievement Award, Gold Category, from Professional Research Consultants Inc (PRC).

The award comes in recognition of team triage, an innovation launched by the ED in 2005.

The sorting of ED patients according to degrees of urgency is a role traditionally performed independently by a nurse. In team triage at VUH, a senior attending physician and a nurse work together from the beginning to conduct initial medical assessments and initiate the care of arriving patients.

With team triage, lab tests and radiological studies are likely to be put in motion before the patient even enters a treatment room. Patients with suspected sprains can be treated with ice packs in the waiting area while their X-rays are examined, and can be out of the ED in a boot or sling in under an hour.

Institutions that have sent representatives to examine how team triage works at VUH have included Massachusetts General Hospital, Barnes-Jewish Hospital at Washington University Medical Center, and University of North Carolina Health Care.

“Our ED shows an exemplary grasp of the principles and improvement strategies promoted through elevate,” said Martin Sandler, M.B., Ch. B., associate vice chancellor for Hospital Affairs.

“I see team triage as a prime example of what can be achieved when there's a strong willingness to innovate. Staff and physicians in the ED have collaborated to develop new solutions and change patient perceptions, and it's been exciting to see the marked progress they've achieved.”

U.S. emergency rooms are working full-tilt. Long patient waits are common, and it's not unheard of for patients to leave without receiving treatment. With team triage, the ED reduced the rate of patients leaving without being seen by more than half. In the last six months, about 2.1 percent of patients left the adult ED without being seen, well below the current University Healthsystems Consortium rate of 3.5 percent.

“In terms of a basic sequence, we've been doing emergency medicine the same way for 50 or more years,” said Corey Slovis, M.D., chair of the Department of Emergency Medicine. “As emergency rooms have gotten busier, it's become obvious that we need to attempt new things to provide faster care and serve more patients.

“With team triage, from door to doctor in 10 minutes is our goal.”

Ian Jones, M.D., assistant professor of Emergency Medicine and medical director of the ED, said the approach is beneficial to patients.

“Team triage has helped in many ways, not least in providing added assurance that the sickest people entering the ED receive care without delay.”

PRC conducts surveys of patient attitudes for VUMC and some 1,800 other hospitals and health systems.

The survey currently reaches patients of 199 emergency departments across the United States, and PRC tells each ED where it ranks among clients nationally.

On two key questions, patients rate their likelihood for recommending to others the ED they've just visited, and they rate the overall quality of the care they received.

From the second quarter of 2005 to the first quarter of 2007, VUH's ED rose from PRC's 75th percentile to its 95th percentile on likelihood to recommend, and from the 80th percentile to the 97th percentile on overall quality of care.

“Team triage has been one of the keys to improved satisfaction, but it hasn't been the whole story,” said Brent Lemonds, R.N., administrative director of emergency services and inpatient medicine. “The care we take to give patients more information and to acknowledge their needs throughout their stay have contributed to this change in perception.

“Faculty and staff in the ED decided in favor of early adoption of elevate. We decided we weren't going to be at the back of the pack,” Lemonds said.

New revenue stemming from the reduction in patients walking out before being seen makes up for the cost of placing attending physicians in a non-billable triage role, Lemonds said.

While most PRC awards are based on which clients rank highest on patient satisfaction, the Achievement Awards are instead based on narrative entries submitted by clients. A committee of 10 judges reviewed 13 entries for the 2007 Achievement Awards in the Emergency Care Category. Judges assigned one Platinum Award, two Gold Awards and a Silver Award. The awards were given out Tuesday at the PRC client conference in Bonita Springs, Fla.

For implementation of team triage, which is based on a program originally developed at Inova Fairfax Hospital in Falls Church, Va., Slovis credits Jones and Lemonds, Chuck Seamens, M.D., and Donna Mason, R.N., manager of patient care services in the ED.