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EMERGENCY DEPARTMENTS: Pull until full

What does “pull until full” mean?

This is an emergency department intake approach intended to have patients seen more quickly by a physician and spend less time in the waiting room.  Also known as no triage or straightback or triage bypass or immediate bedding, this approach involves taking a patient immediately into an ED exam room and having intake processes occur in parallel at the bedside.  Among the pioneers of this approach has been the University of California, San Diego.

Allnurses.com – the networking site for nurses – has an interesting discussion thread about pull until full triage that can be viewed here:  http://allnurses.com/emergency-nursing/pull-until-full-900834.html?s=ded182bfe6a271b0370397ebef0ce698.  I always enjoy this site because it has candid feedback from hospital nurses who talk about practices in their hospitals.  Some of the nurses on this discussion thread mentioned that this strategy works early in the morning and then the ED fills up.  These commentators also mention how nursing staff work together in the ED.

A recently-published article (Zocchi, et al., 2015) indicated that the “pull until full” approach was the most frequently implemented strategy to improve patient flow in the emergency department among a 42-hospital collaborative.

Sources: 

Welch, S.J. (2009, Mar.). Flow mapping for efficiency. Emergency Medicine Newshttp://journals.lww.com/em-news/Fulltext/2009/03000/Flow_Mapping_for_Efficiency.6.aspx

Welch, S.J., and Davidson, S. (2010, May-June). Exploring new intake models for the emergency department. American Journal of Medical Quality. 25(3), 172-180.  http://www.edbenchmarking.org/uploads/exploring-new-intake-models.pdf 

Zocchi, M.S., McClelland, M.S., and Pines, J.M. (2015, Dec.). Increasing throughput: Results from a 42-hospital collaborative to improve emergency department flow. The Joint Commission Journal on Quality and Patient Safety, 41(12), 523-541.  http://www.ingentaconnect.com/content/jcaho/jcjqs/2015/00000041/00000012/art00001  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

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