Efficiently managing emergency department (ED) patient flow, personnel and discharged patients can be difficult in any conditions, but the pandemic presented its own set of challenges. Virginia-based Inova Fairfax Hospital developed an innovative approach to address these issues by implementing what it calls Provider-Only Patient (POP) protocols for patients suspected of having COVID-19, notes a recent NEJM Catalyst report.
The hospital developed a designated area in the ED where low-acuity patients were seen and discharged directly by physicians or advanced practice providers. POP protocols were followed for patients 21-64 years old suspected of having COVID-19 who had an emergency severity index score of 4 or 5 on a scale of 1 to 5, with 1 being the most urgent.
Patients entering the ED initially were triaged by a nurse or physician to determine POP status. Those who exhibited signs of hemodynamic instability (e.g., hypo- or hypertension), had room air oxygen saturation below 96%, were pregnant, had difficulty ambulating or who had inadequate social support were not included in the POP patient queue.
Inova studied the results of the program for a 46-day period between Dec. 1, 2021, and Jan. 15., 2022, and found some interesting results.
POP patients spent significantly less time in the ED than non-POP patients and none of the 640 POP patients returned to the hospital for admission within 72 hours. The study’s authors also reported that the POP triage and delivery process saved nearly 1,900 hours of nursing and 705 hours of provider time during the 46-day study period.