Summary To address changes in the health care landscape precipitated by the Covid-19 pandemic, particularly the lack of health care personnel, the ED at Inova Fairfax Hospital developed a process to evaluate and treat patients under a Provider-Only Patients (POP) protocol involving only physicians or advanced practice providers (APPs). In this article, Inova reports on the development of the POP process and the outcomes of a cohort of patients with suspected Covid-19 who were seen in the ED as POP patients between December 1, 2021, and January 15, 2022. All of the POP patients had Covid-19–related complaints, had an Emergency Severity Index (ESI) of 4 or 5 (on a scale where 1 is most urgent and 5 is least urgent), required limited nursing intervention, were discharged, and were 21–64 years of age. Any patients who exhibited signs of hemodynamic instability (e.g., hypo- or hypertensive), had non–Covid-19 complaints, had room air oxygen saturation below 96%, were pregnant, had difficulty ambulating, and/or had inadequate social support were not considered to be a POP patient and were seen in the regular queue of patients. Inova developed a designated area in the ED where patients were seen and discharged directly by the provider. Patients were first triaged by a triage nurse or physician to determine POP status. As of January 2022, Inova’s ED had seen 640 POP and 2,386 non-POP ESI 4 and 5 subjects (4.4% of the total ED census). Although the mean time from ED arrival to bed favored non-POP patients by approximately 9 minutes, the mean time from initially being seen by a provider to the discharge disposition and the mean time from discharge disposition placement to leaving the ED significantly favored POP by 48 minutes and 66 minutes, respectively. No POP patients returned within 72 hours for admission to the hospital, which supports the integrity of the POP triage and care delivery process. The authors estimate that the 640 patients who were part of the POP process saved approximately 1,892.27 nursing and 705.1 provider hours during that 46-day study period. No additional physician or APP hours were required, which suggests that POP is a safe, efficient, and effective process that can significantly reduce provider-to-disposition times and overall discharge length of stay. In addition to its value in mitigating the pandemic-related staff shortage, the POP model may also be considered to address nonpandemic-related staffing challenges.
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