Background: Overcrowding in the Emergency Department (ED) has been a global 
concern over the past three decades and has posed a threat to public safety leading to poor 
quality of care.  Overcrowding is caused by an increased number of patients presenting to 
the ED and patients waiting in the ED for admission or waiting transfer to another 
facility. 

Purpose: The purpose of this Doctor of Nursing Practice project was to implement 
a Rapid Medical Evaluation and Treatment (RMET) process in the ED. The RMET 
process will be led by a medical provider who initiates the diagnostic workup, treatment 
and disposition for emergency patients requiring low-resource utilization (Emergency 
Severity Index or ESI IV & V). 

Design/Methods: A pre-post design was used to evaluate this project.  Pre
implementation data was collected over 18 months (January 2017 to August 2018) in a 
community hospital in California. Primary outcomes were door to provider time (DTPT), 
length of stay (LOS), left without being seen (LWBS), and patient satisfaction scores 
based on Press Ganey Satisfaction Survey. Due to delay in construction, the RMET 
implementation is still pending.  Post-implementation data collection will be collected 
once the construction is completed.  

Results: Pre-RMET implementation data showed an average ED volume of 4200 
patients per month with a spike in January to 4822 patients seen.  During pre-implementation, there was a median DTPT of 26.50 minutes.  The spike in volume 
during January 2018, there was an increase in DTPT of 153 minutes.  The median LOS 
for discharged patients was 139.4 minutes (2.3 hours) and for admitted patients, it was 
338.5 minutes (5.6 hours).  The median percentage of patients LWBS was 1.5% over 18 
months.  The median patient satisfaction based on Press Ganey Satisfaction Survey was 
87%.
 
Conclusion: The evidence summarized in this project suggests that having low
resource intensive emergency patients cared for using a RMET process will mitigate ED 
overcrowding by decreasing DTPT, LOS, LWBS and maintain or increase patient 
satisfaction.  Post-implementation will require ongoing evaluation of project metrics to 
show whether this is the case.