Short on Time: Minimizing the Door-to-Doc Wait Time

In recent years, a patient’s wait to see an Emergency Department (ED) physician increased dramatically. From 1997 to 2004, the median wait rose to 30 minutes, an increase of 36%. By 2005, most patients saw a physician within an hour, but over 25% waited an hour or more. As a result, patient satisfaction and quality of care suffered.

Now, research suggests several ways to minimize door-to-doc time.

One successful approach replaces traditional triage, which takes up to 10 minutes, with short-form triage, which takes 1 to 2 minutes. This briefer triage collects only the most important details, such as chief complaint and acuity level. 

Another approach combines triage and registration. In this 5-minute approach, a quick-look nurse obtains the chief complaint and enough details (for example, vital signs and allergies) to assign an acuity level, such as emergent or nonurgent. At the same time, a registration clerk gathers only the data needed to start a medical record: name, date of birth, and Social Security number.

Other approaches that trim door-to-doc time: 

  • Bedside registration 
  • Check-in kiosks 
  • Low-acuity fast track 
  • Split-flow management, which creates subgroups for sick and less-sick patients

According to Eileen Robinson, Director, Nursing Continuing Education at Elsevier, “Learning effective and efficient triage is an advanced skill for experienced ED nurses and lays the foundation for adapting to expedited triage. The Emergency Nurses Association has developed a new web-based course, Emergency Nursing Triage, which provides that triage foundation.”

For more details on this course and others offered in Mosby’s eLearning call 866.416.6697.

The High Performance ED: Optimizing Capacity and Throughput to Meet Ever-Growing Demand. The Advisory Board Company. 2008. Available at Accessed September 18, 2008.

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