Methodist Hospital of Sacramento

Methodist Hospital of Sacramento is a community hospital with an annual Emergency Department census of 45,000 patients. The census has been growing at over 5% per year, but the size of the ED remained at 15 beds for years. With this increasing volume and a new expanded ED over 1 year away, the Left Without Being Seen and Length of Stay was increasing. EPMG and Methodist Hospital leadership believed that a new process was needed to decrease these rates, something dramatic and "outside the box."

In early 2008 the entire process of patient flow was revisited, and it was determined that the bottleneck of patient flow culminated at triage to bed. The Doctor in Triage model was considered and deemed not sufficient. Instead a "Triage Pod" was created, in which 6 of the 15 beds in the department were turned into a triage area. Four nurses and 2-3 physicians or mid-level providers staff the area, and patients are greeted by a nurse as they walk into the ED and sent directly to a triage bed. In this bed a nurse triages the patient and a physician evaluates the patient; each patient is to only stay in the triage bed for 15 minutes.

Physicians have 3 options after seeing a patient:
1. If it is a simple case and no tests are required, the patient is
immediately discharged.
2. If the patient requires radiographs or laboratory testing and is
stable, the patient is sent to the waiting room, waiting for the test
to be performed and for the results.
3. If the patient requires monitoring or treatments, they are sent to
an ED bed. This concept is based on the fact that about 60% of ED
patients do not need to remain in a bed for their ED stay.

With the help of administration and the ED staff this has made a dramatic change in the walkout rate, length of stay and door to doctor times. Our patient satisfaction scores have also been steadily rising. Our results have been sustained, even through a 10% increase in patient volume over the last year.

In February 2009, our new expanded emergency room opened with the capacity to treat 75,000 patients a year in nearly 3 times the space of the old ED. As we progressed into this new ED, both our physicians and our nurses have agreed that the process works so well that we will continue the "Triage Pod." It is viewed as the fastest, safest and best practice of Emergency Medicine at Methodist Hospital.