Overview

Who and When: Intake team is every day from 4 PM – 11 PM, consisting of an Intake PEM Attending (from Team 1), RN, and Medic

What: Assess patients and execute orders for patients on the condition list (below) whenever there are patients waiting in the lobby to be seen

Where: Team 1, rooms 6 and 7

Why: Our primary goals are to (1) decrease Door-to-Provider time, and (2) deliver timely, reliable care for those with time-sensitive diagnostic or therapeutic interventions

The Process

  • When all ED rooms are full, the Intake team RN and Medic will pick patients from the lobby based on chief complaint, or after a patient is triaged.
  • The first patients to be seen by Intake are the ones on the list of conditions. When there are no condition specific patients waiting in the lobby, patients should be seen by Intake in the order they arrived to the ED.
  • Intake Medic will bring patient to a room in team 1 and start VS.
  • Recommended script for patients and families seen in Intake:

o   “Hi! My name is XXX and I am one of the Nurses/Medics. I am going to bring you back to a room where you will see a physician, nurse, and Medic team. You are a part of a rapid team that allows patients and families to see a physician faster and get care started. You will be in this room for about 15 minutes and we will ask you some questions, do an exam, and may order medications and tests if appropriate at this time. After this room, you will either go back to the lobby and wait for your room to become available, or go straight back to a room if one is open. You will then see another part of our team to complete your care. If anything changes while you are waiting, please notify the RN in the lobby.”

  • Intake RN and MD will do team assessment.
  • A team assessment will be followed by order placement and execution of orders including targeted therapy if indicated, taking advantage of available order sets when possible.
  • Intake MD documents a team assessment note (.EDINTAKE).
  • RN documents regular triage questions, screenings, and notes per usual routine.
  • If there are no rooms and patient is not a priority, patient is sent to the lobby to wait for next available room in the ED. Intake team patients fall into the regular lobby cue (roomed by priority and time in department).
  • Patient will be sent to x-ray, room, or lobby by Intake Medic.
  • The Intake MD is responsible for fielding calls from the lab and radiology regarding diagnostic studies which are performed during the Intake team evaluation until the patient is roomed and assigned to another provider team.
  • When a patient is roomed, the provider team taking over care of the patient will be able to see an indicator on the track board which denotes that the patient has been seen by the Intake team – this means that an Intake team assessment note should be found in the “Notes” section of the chart. No face-to-face hand off takes place, but all relevant information from the Intake team, including an explanation for any orders that were placed, should be found in the team assessment note.

Priority Condition List

What This Means For Residents

  • If a roomed patient has an indicator on the track board noting that they were seen by the Intake team, you should:
    • Look for the Intake Team Assessment Note in the chart
    • Be aware that orders for preliminary diagnostic studies and interventions may have already been placed and completed
  • Your attending (Team 2 or Team 3) will NOT be one of the Intake Team attendings – the Intake Team attendings are from Team 1, where residents are not currently assigned.
  • You are still responsible for:
    • Performing a full history and physical examination
    • Developing a comprehensive assessment (including differential diagnosis) and plan for the patient, which may or may not agree with the assessment and preliminary plan of the Intake Team
    • Documenting an ED Provider Note
    • Following up on all aspects of the patient’s care once you have assigned yourself to the patient

Feedback

  • We want to hear from YOU about how this process is going! Please contact Tina and Brad with any positive or constructive comments about this process.
  • We will be looking for ways to involve residents with the Intake Team, both through the formal ED rotation and through elective rotations. If you have any thoughts on this, please let us know!
  • Interested in being more involved?
    • Scholarly work will be ongoing to develop evidence-based clinical care algorithms for the conditions commonly encountered by the Intake Team
    • If you are interested in participating in the process to develop these algorithms, please let Tina and Brad know!