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EMERGENCY DEPARTMENTS: What is a pivot team?

The patient flow through the emergency department at the University of Colorado Hospital (Aurora, Colo.) was redesigned as part of preparation to move into a new, much larger facility (increasing from 18,000 to 56,000 square feet) in spring 2013.  The centerpiece of the patient care redesign was establishment of a pivot team approach, which has proved successful in decreasing patient length of stay in the ED and in eliminating ambulance diversion and nearly eliminating the number of patients leaving without being seen.

The pivot team approach is depicted in detail in the document cited below authored by the University of Colorado hospital.  The patient entering the ED has an ID check with security and then moves to an ambassador who shows the family where to wait and takes the patient to the PIVOT team, where a very fast decision is made to send the very sick patients immediately to the ED pod area and the less-sick to Intake for more in-depth assessment.  Patients are in Pivot for only 2 or 3 minutes and vital signs and medical history are not taken at this point.


Robeznieks, A. (2015, Jan. 5). Hospital revamp cuts ED wait times. Modern Healthcare, 45(1), 29. Retrieved from http://www.modernhealthcare.com/article/20150103/MAGAZINE/301039996

Scott, R., and Koehler, A. (2013). Evolution in emergency care: The pivot team. Journal of Nursing Care, 2(3). Retrieved from http://www.omicsgroup.org/journals/2167-1168/2167-1168-S1.002-067.pdf 

University of Colorado Hospital. (2013). Emergency department care redesign using the novel rapid process optimization (RPO) methodology. Retrieved from http://smhs.gwu.edu/urgentmatters/sites/urgentmatters/files/EDCareRedesignRPOMethodology.UColoradoHospital.pdf