Website spotlight: ’Bed wizards’ transform ED throughput

Nurse Leader Insider, July 25, 2011

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The introduction of a new role in the emergency department at St. John's Hospital in Springfield, MO, has transformed throughput and improved patient experience.

The ED was experiencing about 220-240 visits each day and wait times were growing so long that patients were leaving without being seen. To improve patient satisfaction, staff wanted to improve the throughput process.

Triage was a big stumbling block for the ED. Nurses greeted and triaged patients in the waiting area, and dealt with radio communication with incoming ambulances and EMS personnel. The nurses often asked patients to wait while they dealt with a radio call. The ED receives 60-90 ambulances every 24 hours, so it was a major distraction for nurses and patients.

Enter "the wizard." Officially known as an ED flow facilitator, the wizard is assigned to radio calls, which allows triage nurses out front to concentrate on the patients in front of them.

The wizard, a registered nurse with exemplary triage experience, triages patients arriving by ambulance and ensures that everything is ready, and serves as a bed czar for the ED whose prime task is throughput.

"The purpose of the flow facilitator is to have one person who would be air traffic controller," says Rachel Corle, RN, one of two wizards in the ED. Corle says the role involves keeping an eye on everything and proactively planning how to move patients through the ED. The wizard watches the waiting room, knows what's going on in the back, and is responsible for assigning patients to beds. The role involves constant communication with the triage staff and all care providers.

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