By Jeff Troth, U.S. Army Medical Department Activity -- Fort Carson PAO
FORT CARSON, Colo. -- The Evans Army Community Hospital Emergency Room has started a new initiative to shorten wait times in the ER. Nurse First puts a nurse at the ER entrance so he or she is the first person a patient sees.
"Within the first minute of patients walking through our doors they are seen by a registered nurse who determines if they need immediate treatment, if they can wait or if we can get them an appointment for later that day or the next day," said Capt. Roger Webb, the Evans ER clinical nurse officer in charge. "We started Nurse First on a trial basis almost two months ago and are currently running it during the ERs busiest times."
Webb said that Nurse First is not conducted every day, but he would like to change that in the future.
The normal procedure for emergency rooms is that patients are first seen by a medical support assistant who checks them in. Patients then wait until a nurse or medic is available to take their vitals.
At this point patients are given an Emergency Severity Index (ESI) number, ranking them from 1 to 5. Category 1 is the highest priority and is for patients who require immediate lifesaving care, while category 5 is for those with less severe issues (acute) -- ear pain, cold symptoms or contusions. Patients in the higher priorities are seen first regardless of when they arrive at the ER.
"This new initiative makes the nurse the first person the patient sees when getting here," said Webb. "If the patient's vitals are ok, the nurse has the patient sign in at our front desk to be seen by a doctor. But, if the patient is really bad off the nurse will have the patient go to the back right away."
For patients in the ESI 4 or 5 categories the nurse gives them the option to either wait for an ER doctor or to see if an acute appointment is available for them that day or the next with their primary care team.
"One day we actually got 39 patients appointments instead of seeing them in the ER," said Webb. "It is their option if they want to wait, or if they want to schedule an appointment so they don't have to spend their day or evening in the ER."
For every appointment the ER staff is able to schedule it means their average of 120 to 140 patients per day decreases. This not only helps those that took the appointment, but also those who opted to wait, especially on the days when the emergency room has over 190 patients walk through their doors.
Besides helping to ease the wait time for patients in the emergency room, Nurse First has also cut down on the number of patients who check in at the front desk, but leave before they are seen.
"Most people who leave without being seen are normally here for a mild illness," Webb said.
"When we have an RN at the front door, he or she is the first person the patient sees, that patient immediately feels taken care," said Col. Timothy Hudson, Evans' chief nursing officer. "What is really impressive about the Nurse First initiative is that it wasn't something that was pushed down from our higher headquarters. It was our ER nurses taking the initiative to research evidence-based studies to see how they could improve their patients' emergency room visit."
Related Links:
Evans Army Community Hospital web page
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