Penn put a doctor at the front of its ER so triage happens during the first exam

In a September 2021 Fast Company article, a profile of the new $1.6 billion Pavilion at the Hospital of the University of Pennsylvania describes how its emergency department was reworked. Penn's average wait was clocked at 80 minutes from walk-in to first seeing a doctor or nurse, and a whole visit for patients not admitted could exceed five hours, most of it in an exam room waiting for lab results or a nurse check-in.

Researchers and clinicians redesigned patient flow in 2019. In the old model, a patient with a non-life-threatening injury sat lower on a priority list until higher-priority cases cleared. In the new one, doctors evaluate each person on arrival, sending a patient with a twisted ankle to one area for a splint and a patient with a stab wound to another to be patched up.

Registered nurse Robin Wood says it flipped the traditional model of triage first and then seeing a doctor: now the doctor sees the patient while triage is being done. Dr. Keith Hemmert says patients now spend half an hour in the exam room, which frees up three-plus hours to see other patients there.

Exam rooms are the scarce resource, and waiting for labs was occupying them.

Seeing a doctor immediately lets the right area be chosen right away.

Moving waiting into semi-private chairs keeps rooms free for those who need them.

The process was proven first, then built into the new department's layout.

If the scarce resource is being used for waiting, redesign the flow so waiting happens somewhere cheaper.

The article says average wait times go down and that the new process informed the Pavilion ER's design, which has semi-private triage areas with reclining chairs, dividers and seating for a guest. It gives no final wait-time figure for the new building.