Surgical Capacity Plan Helps A Busy Emergency Department Get Patients Seen And Treated

Joey Robertson, RN

Resource Coordinator, Emergency Department, St. Joseph’s Hospital

Smart Living: The need for emergency services never seems to dwindle or slow down. How do the nurses in the ED handle the daily influx of people?

Joey Robertson: While we are providing care, we are also tracking how busy we are, using an early warning system called the National Emergency Department Overcrowding Scale, or NEDOCS. When the NEDOCS score reaches a certain level, our nurses employ a surge capacity plan in which everyone is working together to make sure patients are being moved into rooms quickly, despite the large numbers. I make continual rounds with the doctors to identify people who are about to be discharged. We also have what are called float nurses helping us. This means they can move from one unit to another when the need is there.  They transport patients upstairs for us, work on discharges, and do a lot of work with medication reconciliation.

Our plan truly involves everyone if necessary. Even co-workers in environmental care help. If they know a certain room has been assigned to a patient in the ED, they put a STAT clean on that room.  And we always keep a close eye on the waiting room and try to get people seen as soon as possible.

SL: Speaking of the waiting room, if I have a need that is emergent but not life-threatening, what can I expect when I walk into the ED?

JR: You’ll first be seen by what we call a GRASP nurse. GRASP stands for Greet, Reassure/Receive, Assess, Sort and Prioritize. That nurse has a list of all the open rooms, and his or her goal is to get you into one of those rooms quickly. Note the last part is Prioritize—this means that the patients in the worst condition are seen first, rather than first come, first served. Most patients understand that and they see us working hard to move them into a room. At that point, an RN or a PCT will get your vitals and history, and very soon after that a physician will see you.

Our goal is always providing the absolute best care, even on the busiest days. We use whatever tools we have, either through the ED or hospital-wide, to make that happen. And even before the day is done, we’ll be looking at potential admissions and discharges, and making our plan for tomorrow.