Karen Murrell, MD
Innovations in Emergency Department Care
“I feel proud of the legacy that we have created. When I work my shift in the ED, I help one patient at a time, but with this enhanced model of care, we have been able to improve care for thousands of patients.”
How can a busy Emergency Department in KP Northern California – with 90,000 visits a year, including 1,500 trauma patients – have a virtually empty waiting room? The answer lies in the model for high-quality emergency care that Dr. Murrell developed with her colleagues at South Sacramento.
It started in 2008 with the Physician-in-Treatment program, which provides patients with immediate care by stationing physicians at the front of the ED. This model provides patients who have low-acuity problems with rapid diagnosis and treatment, and it has created capacity in the other sections of the ED for higher-acuity patients. The impact of Physician-in- Treatment on patient flow and safety has made it the standard in Emergency Departments throughout the region.
Dr. Murrell and her colleagues further enhanced the flow of patients by deploying a computerized team assignment system to match mid- and high-acuity patients with their physicians. She also established a clinical decision area, managed by emergency medicine physicians in collaboration with hospital medicine and other specialties. Another partnership Dr. Murrell forged resulted in the assignment of a hospital medicine physician to the ED.
While Dr. Murrell reports that no one in the ED would choose to go back to the old way of doing things, change is never easy. “One thing I’ve found really useful in changing a culture is to always put the patient at the center. The other critical component is having a vision. Ours is written on a big banner that says, ‘Our vision is to be the best Emergency Department
in America.’”