A Novel Approach to Addressing an Unintended Consequence of Direct to Room: The Delay of Initial Vital Signs.

Joseph Basile,Elias Youssef,Bartholomew Cambria,Barry Hahn,Brahim Ardolic,Jerel Chacko,Karyn Treval

doi:10.5811/westjem.2017.12.35068

Abstract

IntroductionThe concept of “direct to room” (DTR) and “immediate bedding” has been described in the literature as a mechanism to improve front-end, emergency department (ED) processing. The process allows for an expedited clinician-patient encounter. An unintended consequence of DTR was a time delay in obtaining the initial set of vital signs upon patient arrival.MethodsThis retrospective cohort study was conducted at a single, academic, tertiary-care facility with an annual census of 94,000 patient visits. Inclusion criteria were all patients who entered the ED from 11/1/15 to 5/1/16 and between the hours of 7 am to 11 pm. During the implementation period, a vital signs station was created and a personal care assistant was assigned to the waiting area with the designated job of obtaining vital signs on all patients upon arrival to the ED and prior to leaving the waiting area. Time to first vital sign documented (TTVS) was defined as the time from quick registration to first vital sign documented.ResultsThe pre-implementation period, mean TTVS was 15.3 minutes (N= 37,900). The post-implementation period, mean TTVS was 9.8 minutes (N= 39,392). The implementation yielded a 35% decrease and an absolute reduction in the average TTVS of 5.5 minutes (p<0.0001).ConclusionThis study demonstrated that the coupling of registration and a vital signs station was successful at overcoming delays in obtaining the time to initial vital signs.

Highlights

The concept of “direct to room” (DTR) and “immediate bedding” has been described in the literature as a mechanism to improve front-end, emergency department (ED) processing
The implementation yielded a 35% decrease and an absolute reduction in the average to first vital sign documented (TTVS) of 5.5 minutes (p
This study demonstrated that the coupling of registration and a vital signs station was successful at overcoming delays in obtaining the time to initial vital signs. [West J Emerg Med. 2018;19(2)254-258.]

Summary

Introduction

The concept of “direct to room” (DTR) and “immediate bedding” has been described in the literature as a mechanism to improve front-end, emergency department (ED) processing. The concept of “direct to room” (DTR), known as “immediate bedding,” has been reported in the literature as a mechanism to improve front-end emergency department (ED) processing.[1] At one institution DTR was referred to as “closing” the waiting room, since patients were taken directly to a bed, when available, without undergoing formal triage and registration in the waiting room.[2] Reducing wait times has been linked to patient perceptions of superior service and increased trust, especially in private hospitals.[3] every ED may have individual front-end processes, most ED visits include patient presentation, registration, triage, bed assignment, and medical evaluation.[4]. The goal is to decrease the backlog of waiting room patients waiting for less-critical tasks and allow registration, nursing evaluation, and medical provider evaluation to occur simultaneously at the bedside.[4,8] More importantly, this facilitates an expedited clinician and patient interaction

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