Rapid Assessment Zone – No Triage

December 5, 2019

Written by Clay Smith

Spoon Feed
A rapid assessment zone of ambulatory patients without initial traditional triage resulted in significant patient flow improvements.

Why does the matter?
Expedited emergency care is important for both patient safety and satisfaction and is an essential core CMS metric for hospitals. Different models have been tried in smaller centers to expedite flow. How would a radical new model fly at a busy, 90,000 patient per year center?

A little cRAZy
This was a before and after study with about 44,000 pre- and post-intervention patients, using a rapid assessment zone (RAZ) instead of usual triage. It significantly reduced length of stay, provider time, left without treatment completion, and left without being seen rates, regardless of ESI level.

Here is the crux of the intervention. A lead triage nurse separated patients up front by age and chief complaint to directly room/bed the higher risk patients prior to formal VS, triage, or ESI scoring. The rest of the patients, who were likely to remain ambulatory were assessed in a RAZ. This consisted of expedited care and a flexible patient care space with 18 patient treatment rooms with reclining chairs, monitoring as needed, and medical gases. It was open 9AM to 11PM and staffed by 4 nurses, 3 techs, 2 APPs, and 1 physician. This was distinct from the 8-bed fast track area. See floor plan and flow plan.

Source
The Effect of a Rapid Assessment Zone on Emergency Department Operations and Throughput. Ann Emerg Med. 2019 Oct 23. pii: S0196-0644(19)30664-X. doi: 10.1016/j.annemergmed.2019.07.047. [Epub ahead of print]

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