No wait at Memorial’s Emergency Department

Patients see a doctor within 6 minutes of coming to the Emergency Department
January 24th, 2017

On any given day, Dr. Gregory B. Collins has one of the most important jobs in Colorado Springs.

Dr. Gregory B. Collins, an emergency department physician at UCHealth Memorial Hospital, and Mark Mayes, director of Emergency Services at Memorial, stand outside one of the intake rooms in the department, where patients see a doctor within 15 minutes of arrival.
Dr. Gregory B. Collins, an emergency department physician at UCHealth Memorial Hospital, and Mark Mayes, director of Emergency Services at Memorial, stand outside one of the intake rooms in the department, where patients see a doctor within 15 minutes of arrival.

As an “intake’’ physician in Memorial Hospital’s Emergency Department, he makes critical medical decisions, whether the patient is suffering a heart attack or a bad case of allergies.

Dr. Collins is a point person in a revolutionary new intake process at Memorial’s Emergency Department that has made a difference in how long people wait to see a physician. For the past year, the average wait time to see the doctor in the Emergency Department is fewer than 15 minutes. Long wait times – the days of spending hours before seeing a physician — have been all but eliminated.

“Patients are impressed with how quickly they see the doctor, and how quickly they are discharged if they do not have a serious ailment or injury,’’ said Dr. Collins, who sees between 80 and 140 patients during a shift at Memorial Hospital Central,  which has more patient visits than any Emergency Department in Colorado.

The new process of treating the sick in the UCHealth Emergency Departments has captured the attention of leading hospitals and universities throughout the United States.

In essence, UCHealth hospitals in Colorado Springs and the Denver-Metro area no longer use triage to sort patients. Triage, a French word meaning “to separate out,’’ has been used to route patients to the doctor in hospital emergency departments for the past two decades, especially as patients turned to the department for care that could be delivered in a doctor’s office. Sicker patients saw the doctor sooner than those who were not as ill, and sometimes, those patients who were not as sick spent hours waiting to see a doctor or for a room in the emergency department to open.

“We are not sorting any more. We’re sending every person to a provider and starting treatment,’’ said Mark Mayes, director of emergency services at Memorial. “The purpose of this is to eliminate the waiting room and expedite patients to see a provider.’’

Dr. Kelly Bookman, senior medical director for the Emergency Departments at UCHealth, said: “We’ve eliminated triage. We have an intake provider in the front of the ED who doesn’t perform triage, but rather makes treatment decisions and expedites care of all patients in parallel – sick and not sick. Stanford, Harvard, Cleveland Clinic and many others have come to the University of Colorado Hospital to see what we are doing.  This is a novel concept that is being replicated by high-functioning organizations across the nation.

“We put the highest level of provider up in the front – those patients who don’t need a bed, we can evaluation and provide a disposition quickly instead of them waiting hours and hours.  For sicker patients, we begin their care by placing physician-driven orders and get them directly to a bed,’’ Bookman said.

Mark Mayes, director of Emergency Services at Memorial, stands outside the Memorial Hospital Central Emergency Department, which treats more patient visits annually than any other Emergency Department in Colorado.
Mark Mayes, director of Emergency Services at Memorial, stands outside the Memorial Hospital Central Emergency Department, which treats more patient visits annually than any other Emergency Department in Colorado.

Getting patients in to see the doctor quickly is not the only benefit of the new process. Data shows that the number of people who leave the Emergency Department without being seen has declined to less than 1 percent and the overall time a person spends in the department has also declined, on average, by 30 minutes.

“Having people leave without being seen is dangerous for the patient and it has ramifications for the hospital.’’

Dr. Collins said that by having “intake’’ at the start of the process, he can discharge patients who are not as sick and provide them with a prescription or resources in the community. Mayes said that 17 percent of patients who have low-acuity illnesses are discharged from the intake process and never get into a room.

For patients who are sicker, Dr. Collins can quickly order appropriate lab or imaging tests, so that doctors have valuable data to inform them of treatment options.

“If a patient is real sick, you get the appropriate work up going so that when you hand the patient off to the next doctor, the labs have already been ordered and the doctor doesn’t have to wait for them, Dr. Collins said. “As busy as we are, the Intake process helps decompress the department and expedite treatment for those patients needing emergent care.’’

Being the point person in a process that involves dozens of care givers and utilization of 68 patient rooms in the Emergency Department at Memorial Hospital Central is rewarding.

“You really feel like you’ve helped your patient, and you’ve helped your department. As a whole, it’s a win-win for everyone,’’ Dr. Collins said.

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.