Expeditors in EDs: Facilitating Patient Throughput

Patients commonly experience lulls in their treatment during the course of their visits to the emergency department (ED). Following the triage of patients, they often wait to be brought back to a room. After initial assessments, they may also need to wait during the diagnostic testing and treatment phases. Wait times can also increase as physicians review patient information and make discharge or admission decisions. During these lulls, emergency physicians may be distracted by the urgent needs of other patients and delays can occur. Expeditors: The Maître d’ of the ED A smoother, more efficient operations model in the ED may help anticipate delays in care. For example, a maître d’ controls the flow of patrons in restaurants, ensuring that guests who arrive are seated quickly, their needs are met, and the table is turned over efficiently for the next customers. With this model in mind, we created a new position at Oregon Health & Science University (OHSU) called an “expeditor” who acted like a maître d’ at a restaurant. The expeditor’s primary responsibility was to ensure patient care moved forward. Other responsibilities included: Communicating with and reassessing patients in the waiting room. Rooming patients as directed by the charge nurse. Assisting with ambulance arrivals. Ensuring pain was controlled and providing analgesics as directed. Placing IVs, drawing labs, and running point-of- care tests. Assisting with the discharge processes (eg, removing IVs and helping patients get dressed). Facilitating patient transport to inpatient units. In the May 2011 Western Journal of Emergency Medicine, my colleagues and I had a study published in which we analyzed the effect of using an expeditor...