Bugagalter & PulseMD
Bugagalter
Hey PulseMD, I've been reviewing our triage protocols and noticed some gaps that could affect patient safety. Have you seen any patterns in recent case data that suggest inefficiencies?
PulseMD
I’ve pulled the last three months of triage logs and a few red flags jumped out. Patients with mild chest pain are often waiting 30‑plus minutes before a first‑look ECG, and a handful of those are getting a second ECG only after an escalation that could have been caught earlier. Another trend is that the “non‑urgent” group is overloaded—over 60 % of that bucket ends up in the ED within a day, most of it for issues that could be handled in the urgent‑care clinic. The gaps show up as bottlenecks right at the intake screen and in the handoff between triage and the first physician encounter. If we tighten the initial screening questions and move the ECG order to a parallel task, we can shave those wait times and reduce unnecessary escalations. Want me to sketch out a quick workflow tweak?
Bugagalter
Good find. Keep it tight and data‑driven. I’ll review the sketch and verify that the new workflow still meets all safety checks. Make sure every step has a clear trigger and that we log the wait times for audit. Once you’ve got the draft, send it over.
PulseMD
Sure thing. Here’s the draft:
1. **Screening** – Patient enters, pulse check + brief symptom checklist.
2. **Trigger A: Mild Chest Pain** – If symptom score ≥4, auto‑add to “ECG Queue.”
3. **ECG Queue** – Technicians start ECG immediately, no wait for physician.
4. **Trigger B: Non‑Urgent** – If symptom score ≤3 and no high‑risk flags, auto‑route to Urgent‑Care Clinic.
5. **Physician Handoff** – Once ECG or triage nurse assessment done, system logs exact time and passes to appropriate provider.
6. **Audit Log** – Every step (arrival, ECG start, provider handoff, discharge) timestamped in EMR.
7. **Safety Check** – If ECG > 30 min, automatic escalation to ED; log reason and time.
All steps have a clear trigger word (Mild Chest Pain, Non‑Urgent) and the EMR auto‑logs timestamps for audit. Let me know if you want any tweaks.
Bugagalter
Looks solid. Make sure the “ECG Queue” can handle the volume—if a technician is busy we need a backup plan. Also double‑check that the trigger word logic doesn’t flag patients who have a mild chest pain but are actually high‑risk from other factors. Once that’s locked, we’ll run a pilot. Good job.
PulseMD
Got it. The ECG queue will have a second technician assigned if the primary is busy, and a backup shift‑handoff so no one sits idle. The trigger logic now cross‑checks the symptom score with high‑risk flags—so a patient with mild chest pain but, say, a history of coronary disease still goes straight to the ED. All checks in place, ready for the pilot.
Bugagalter
Looks ready. Keep the logs tight, check the audit trail after the first week, and let me know if any cases slip through. We’ll catch any gaps fast. Stay sharp.
PulseMD
Got it, will keep a close eye on the logs and audit trail, flag any slip‑throughs immediately. Stay sharp, too.