RESUMO
OBJECTIVE: To assess the effect of having a physician or physician's assistant (PA) as patients' first point of contact in our emergency department (ED) on the rate of leaving without being seen (LWBS) and wait time. METHODS: In before and after intervention conducted in the ED at a 265-bed community hospital, data were collected on all patients presenting to the ED during a 70-month period. A physician or PA was stationed in triage 16 hr a day. The screening process included measurement of vital signs, a brief history and physical examination, and computerized physician order entry. RESULTS: During the study period, volume increased from 86,000 to 102,000 patients per year. Monthly averages for ED visits increased 16%, admissions increased 5%, and ambulance visits increased 18%. The rate of LWBS decreased from 3.1% to 1.7%. Door-to-doctor time decreased by 14 min. CONCLUSIONS: Despite an increase in patient census, the LWBS rate and door-to-doctor time decreased. This study of one solution to the issue of ED crowding demonstrates how a process redesign can lead to successful changes in throughput metrics.
