When space in the Emergency Department is limited, identifying a Rapid Treatment Area (RTA) could solve a plethora of issues – decreasing wait times, waiting room decompression, efficient assessment of patients and overall patient satisfaction. Working in conjunction with the use of triage bypass and the use of standard of care order sets based on chief complaint, RTA is known to improve patient throughput times.
Identify the Space
The first step in the process is identifying a space that is convenient to the triage area in which a provider can perform a medical screening exam (MSE) and will serve as the Results Pending Area (RPA). The capacity of RTA and the RPA area is dependent upon available space and the emergency department’s volume and acuity. Patients who would normally be sitting in the ED lobby waiting for beds to become available now have their assessments and necessary diagnostic testing initiated shortly after arrival. This creates continual forward progression for the patient and productive waits.
RTA is a flexible process that can be scaled up or down depending on support staffing and arrival/acuity patterns. A physician or APC can always perform a MSE with order entry regardless of the staffing on a given shift. With a dedicated RTA nurse, lab and radiology orders are processed, patients can be appropriately medicated and lower acuity patients can be treated and discharged from this area.
Improve Turnaround Times
The RTA is especially effective at improving turnaround times for patients triaged as ESI level threes (in the five-level ESI triage system). In the majority of emergency departments, ESI level one and two patients are immediately brought directly to a bed in the main ED, and ESI level four and five patients are often sent directly to a fast track or lower acuity area. RTA enables an ED at capacity to ensure that the ESI 3 patients, who traditionally have the longest wait times, are expeditiously seen by a provider and have their workup initiated. Since wait time is now productive for this group of patients, much of their diagnostics are resulted when they arrive to a bed. This significantly decreases disposition decision times improving patient throughput on the back end as well.
Value Stream Mapping
Emergency departments nationwide are developing strategic plans to improve patient flow throughout each patient visit. Utilizing a process called VSM – Value Stream Mapping, ED’s are guided through exercises to help determine the best course of action for any given issue. Value stream mapping is a lean manufacturing or lean enterprise technique used to document, analyze and improve the flow of information or materials required to produce a product or service for a customer. This approach provides a thoughtful guideline for administrators to understand the value of utilizing RTAs.
In order for this planning technique to be successful, the team must identify the purpose, scope, starting/stopping point, as well as out of scope points, for each step of an ED visit. Breaking down each piece of an ED visit, allows teams to identify wins, challenges and steps that could potentially be eliminated, in order to streamline the process.
Thoughtful planning and coordinated execution of RTAs make a significant positive impact on patient throughput, quality of care, clinical outcomes, reduction of LWBS and LWOT, and patient satisfaction.
