Nonprofit Innovation Awards: Hospital's emergency department flips process for healthier results

Winner: Management Operations

It's a dilemma shared by hospital emergency rooms around the country: how to serve more people in the same amount of space - without compromising the quality of care or holding up its delivery.

At York County's Memorial Hospital, the solution has meant overhauling the way patients flow through the emergency department. The department handles more than 40,000 patients a year, up from 15,000 a decade ago.

The biggest change, instituted in October, plants a doctor in the waiting room to help sort patients and point them where they need to go. The hospital also added new positions and revamped its registration procedures so they don't stand in the way of patient care.

"It's a complete change in thought process for our emergency-room staff," said Kandy Duncan, emergency-services director at Memorial, which is in Spring Garden Township.

Patients with stab wounds, crushing chest pains or other serious conditions still head directly to a bed in the emergency department, Duncan said. Other patients are divided into three groups by a doctor in the waiting room, known as a physician in triage, or PIT.

"We've actually flipped the ER on its back because, traditionally, the last person you saw when you came in for treatment was the doctor," Duncan said.

Patients who need X-rays, IVs or other diagnostic procedures start getting that work done in the waiting room. If privacy is needed, doctors can use one of two small treatment rooms off to the side.

People with cuts, broken bones, earaches or other ailments are sent through what is called the FastER, where they see a physician assistant who can wrap up treatment. People with minor ailments, such as a nagging cold, receive prescriptions.

To speed patient flow, Memorial created two new positions solely for the ER. One is a vascular access technician, a lab tech able to draw blood and start IVs. The second is a flow tech, a person who takes care of administrative tasks for the physician, such as checking on test results.

Another key innovation is a process called short registration, or short reg. A nurse takes down basic information - name, birth date and chief complaint - and enters it into a computer system that others in the ER can use to track the patient. The more extensive registration can wait until down time during treatment, Duncan said.

This summer, the ER's space will undergo renovation to accommodate the changes in personnel and procedure.