Low-acuity patients are not appropriate for an ED, but they must be assessed by a physician before they can be sent home. Physicians are usually at the back of the ED, meaning patients must first undergo nurse-triage and go to a back bay before seeing a physician.
Putting a physician at the front end means low-acuity patients can be sent home earlier and frees up the ED for high-acuity cases, Mr. Howard says. In the Methodist ED, a physician staffs the check-in area of the ED during peak times from 11 a.m. to 1 a.m. An ED technician takes vital signs; then the physician examines the patient in one of four triage rooms.
Results of physician-triage
This unusual approach, developed internally and introduced in 2004, keeps wait times down and relieves congestion in the back rooms. Patients are treated within a half hour of arrival and patient satisfaction scores for the ED are unusually high. To staff this service, the hospital employs five physicians who would otherwise be working in the back.
However, Mr. Howard says the service has attracted more low-acuity patients to the ED. Volume of low-acuity cases, such as common toothaches, headaches and stomachaches, has almost tripled, from 5,000 in 2004 to 14,000-15,000 a year now, or about 25 percent of ED volume. These patients do not improve hospital finances because they are not admitted.
“Some of these patients come in multiple times,” Mr. Howard says. “We’ve seen them before.” Many low-acuity patients are Medicaid recipients who have an assigned physician at the local federally qualified health center. Methodist has been working on ways to immediately identify them and send them directly to an FQHC physician.
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