Reducing Wait Times

Emergency Department Changes Have Big Impact

Jade Enos, Enloe Health’s Emergency Department Nurse Manager, stands in the “chair care areas,” which have helped reduce wait times in the Emergency Department.

Nobody likes to wait. But the unwillingness to wait becomes especially keen when a person is sick or injured.

Fortunately, wait times at Enloe Health’s Emergency Department are improving. A lobby reconfiguration and reallotment of personnel have made “fast-tracking” patients the standard, and wait times have decreased as a result.

In 2022, a staggering 13.4% of patients waiting for care left without being seen. It was a crisis until caregivers developed a plan that established four “chair care areas” in the department, increased lobby staffing to two triage registered nurses, two licensed vocational nurses and two Emergency Department techs. “Fast-tracking” patients by way of specially trained nurses — thus providing immediate care — and expanding physician coverage to implement orders and work with the nurses and techs has helped ensure patient care in these chair care areas. The fast track system exists at many other Emergency Departments, said Jade Enos, Enloe Health’s Emergency Department Nurse Manager.

By January 2024, the left-without-being-seen rate had plunged to 2.3%. Today, that rate remains much lower than the 2022 figure.

New Approaches Prove Effective

Through a lot of research and a visit to Sutter Health’s Roseville hospital, Enos discovered the concept of six recliners in the Emergency Department lobby called “chair care.” “Sutter Roseville was in the same situation we were, with overcrowding — even with a new ED,” she said.

Along with setting up the chairs, Enos said her group also had to figure out how to reconfigure the lobby.

This meant repurposing enclosures like the original kids room, which was underused, and adding a second triage room. There also needed to be areas to accommodate a place for lab draws, electrocardiograms — tests that record heart rhythms — and assessing and prioritizing illnesses and injuries.

Emergency Department technicians became more mobile, Enos said, allowing for more “eyes on” lobby patients. “They’re seen and heard and know someone is there,” she explained.

The results were astounding. The left-without-being-seen rate plunged and helped shave the “door-to-M.D.” time by 15 minutes and cut the average length-of-stay time by 30 minutes.

All this despite the department seeing a record-breaking 7,000 patients in the Emergency Department just in January 2024.

Cindy Llewellyn is Enloe Health’s Director of Critical Care Services & Emergency Department. She recalled with discomfort the left-without-being-seen rates in 2021 and 2022. They reached 13%. The standard is 2%, she explained.

“That presents high risks for patients and the community and their medical concerns,” Llewellyn said. “We looked at what was driving that. It was a combination of staffing and the process of passing through a system.

“Our leadership team worked collaboratively with the physicians. We trialed many different locations for fast track, the physicians rearranged their start times on multiple occasions and we focused our efforts to improve staffing. We continue to evaluate our processes and have maintained a left-without-being-seen rate of less than 5%.”

A ‘Great’ Experience

Megan Prott needs no convincing on whether the new system is faster and more effective. She arrived at the Emergency Department one chilly Sunday in January, having broken her left elbow after slipping on ice in a parking lot.

Prott, who’s part of the Enloe Health Foundation, had memories of going to the Emergency Department several years earlier and spending 9 hours there. Not this time.

“I slipped at 8 a.m. and was in the ER by 9 a.m.,” she recalled. “I thought I might spend my entire Sunday there. The lobby wasn’t packed, but there were a few people in there. I knew I would be a low priority because it wasn’t a compound fracture.”

To Prott’s delight, she was out the door in less than 2 hours.

“They triaged me and took me to get X-rays,” she said, “and then they brought in someone from Orthopedic Trauma to put on a temporary cast.”

Prott called Orthopedics the next day and arranged surgery.

“The ER process was great,” she said. “Everyone was really kind.”