RAPID MEDICAL EVALUATION & TREATMENT IN THE EMERGENCY DEPARTMENT

Background: Overcrowding in the Emergency Department (ED) has been a global concern over the past three decades and has posed a threat to public safety leading to poor quality of care. Overcrowding is caused by an increased number of patients presenting to the ED and patients waiting in the ED for admission or waiting transfer to another facility. Purpose: The purpose of this Doctor of Nursing Practice project was to implement a Rapid Medical Evaluation and Treatment (RMET) process in the ED. The RMET process will be led by a medical provider who initiates the diagnostic workup, treatment and disposition for emergency patients requiring low-resource utilization (Emergency Severity Index or ESI IV & V). Design/Methods: A pre-post design was used to evaluate this project. Preimplementation data was collected over 18 months (January 2017 to August 2018) in a community hospital in California. Primary outcomes were door to provider time (DTPT), length of stay (LOS), left without being seen (LWBS), and patient satisfaction scores based on Press Ganey Satisfaction Survey. Due to delay in construction, the RMET implementation is still pending. Post-implementation data collection will be collected once the construction is completed. Results: Pre-RMET implementation data showed average ED volume of 4200 patients per month with a spike in January to 4822 patients seen. During pre- iv implementation, there was a median DTPT of 26.50 minutes. The spike in volume during January 2018, there was an increase in DTPT of 153 minutes. The median LOS for discharged patients was 139.4 minutes (2.3 hours) and for admitted patients, it was 338.5 minutes (5.6 hours). The median percentage of patients LWBS was 1.5% over 18 months. The median patient satisfaction based on Press Ganey Satisfaction Survey was 87%. Conclusion: The evidence summarized in this project suggests that having lowresource intensive emergency patients cared for using a RMET process will mitigate ED overcrowding by decreasing DTPT, LOS, LWBS and maintain or increase patient satisfaction. Post-implementation will require ongoing evaluation of project metrics to show whether this is the case.