"Physician in Triage" program shortens ER wait times at St. Joseph Hospital

As the largest hospital in Humboldt County and home to a Level III Trauma Center, Providence St. Joseph Hospital Eureka’s Emergency Department has seen a steady increase in patients since the COVID pandemic. As the number of patients grew, clinical staff sought a solution to ensure everyone received timely, high-quality care, especially during peak daytime hours. Their answer: adding a “physician in triage” (PIT) program to the intake and processing of ER patients in October 2024.

The results of the PIT program: significantly shorter wait times, more ER patients treated in less time and better outcomes for cases where every minute matters.

Before the addition of a PIT, explains Kristen Hansen, director of nursing for St. Joseph Hospital, ER wait times at peak hours could reach as long as eight hours for non-life-threatening issues, with as many as 30 people waiting to be seen. Nurses could manage initial triage by assessing patient condition and ordering basic lab tests, but they could not order medications or advanced imaging.

Dr. Benjamin Cramer, emergency medicine physician and Dr. James Goldberg, chief medical officer at St. Joseph Hospital, championed the PIT model for the ER. The goal is to have the triage team – a doctor and a nurse – see each ER patient within 10 minutes of their arrival during peak daytime hours. The team can address needs ranging from screening for life-threatening conditions to determining if someone’s cough requires an x-ray or merely a prescription.

With the PIT program, average ER wait times for an exam room are now about 30 minutes. In addition, provider orders for pain medication are given quickly after the triaging, treating a patients’ pain in less time. “One of the biggest patient concerns comes from people who need pain medication but can’t get it ordered until they’ve been seen by a provider in an exam room,” says Hansen. The wait time for such medications has been reduced under the PIT program by about 25%.

The feedback from patients about shorter wait times has been enthusiastic. “Parents with young children would dread potentially spending long hours in the emergency department when they couldn’t get in to see their primary doctors,” Dr. Cramer says. “Now they’re seen and potentially discharged within 30 minutes of coming to the ER. They’re happy we saved them from long wait times and possible exposure to other patient’s illnesses as they waited for treatment.”

 With shorter wait times, doctors and nurses can see more ER patients in a day. And as word gets around in the community about the faster, better ER experience, the PIT program is also expected to reduce the number of people who come to the ER but leave without being seen.

“We really wanted to capture those people,” says Hansen. “We can’t have people who need care staying home because they’re worried about the wait time in the ER. The community should know that we’re working hard to improve their experience.”

The St. Joseph Hospital ER experience is now faster and better – but most important of all, it’s saving lives and preventing serious patient conditions from worsening.

In December 2024, Dr. Cramer was on PIT duty and saw a patient who complained of a severe headache, which isn’t necessarily life threatening. Dr Cramer was able to see her within three minutes of her arrival, and after identifying concerning aspects of her story, a CT scan was quickly ordered, and in just a few minutes, the PIT team saw signs of a subarachnoid hemorrhage, a type of stroke. The patient received immediate care for the hemorrhage, which has up to a 50% mortality rate without timely treatment.

“The PIT program saved her life,” Dr. Cramer says. He can point to similar such cases where rapid diagnosis spotted severe conditions in just a few minutes – like a man with leg pain who turned out to have a dangerous arterial blockage in his leg and was quickly treated. Without such speed, the man might have lost his leg.

“In each case,” Dr. Cramer says, “we were able to perform advanced imaging and other tests within minutes of their arrival, saving those patients from grave danger.”