On the up and up: Sentara’s upright vertical care model improves emergency room experience for patients and staff

Starting in 2016, Sentara’s emergency departments began rolling out a new way to triage and treat patients, called “vertical care,” which replaces traditional horizontal stretchers with comfortable chairs for patients who can comfortably sit upright based on their physical condition and medical needs. 

Instead of having providers go room-to-room checking on patients, they now see patients right away in a centralized assessment room where they can order medications, imaging, and labs. 

“The vertical care area puts you in front of a provider faster and you have the potential to be discharged or admitted sooner, just because we start things almost from the jump versus waiting for a room to become available,” said Ashley Lee, manager of the emergency department at Sentara CarePlex Hospital in Hampton, Va.

If a patient is assessed and they don’t need a bed, they are fast-tracked to the vertical care area to await test results in a comfortable recliner. 

Under this system, beds and rooms are available to the sickest patients who need them the most. Every patient is seen and has their needs addressed quickly and efficiently.

“It was very nice going into the area with the doctor and the nurse, being able to talk to them and getting an IV started right then and there,” said Precious Knight, who came to the emergency department with severe nausea and vomiting. “It allowed for me to not have to explain myself more than one time, I hate that.”

Not only does vertical care create a mental and physical barrier between patients with non-urgent and critical conditions, it also shortens the length of stay, improves efficiency, and ultimately increases patient satisfaction.

“Patients aren’t brought to the back where the critical patients are, where our psych patients are, so they're up front and it's safe, and they try to get you moving quick,” said Chris Durkac, emergency department registered nurse at Sentara CarePlex Hospital.

Darren Rossler, M.D., emergency department physician at Sentara CarePlex Hospital, is seeing more non-urgent patients than he was used to. Though, it does come with its perks.

When Darren Rossler, M.D., emergency department physician at Sentara CarePlex Hospital, is in the vertical care assessment room he typically sees less critical patients with mild chest pain, abdominal pain, and obstetrical issues.

“With physicians, burnout is a big thing so having a less stressful shift is never a bad thing. I think it will promote longevity, at least for me. In a few days I'll be working in the critical side, so it'll be nice to be back over there,” said Dr. Rossler. “It’s good to have a mix.”

Sentara CarePlex Hospital has been using the vertical care workflow for the past three years, but it was only this month that a newly renovated emergency department has allowed the process to flow much smoother.

Staff have better line of sight on their patients. All of their needed supplies are located where they need them, spaces are smaller which reduces staff steps to complete tasks, and communication with team members is more easily accomplished.

In her 28 years with Sentara, Melissa Fritz, director of clinical process improvement, said vertical care has probably been one of the most transformative projects she’s worked on.

“It truly shook up the apple cart when it came to what our typical ED operations look like, and it dramatically changed the way ED providers and nursing teams worked,” said Fritz. “They used to work very much in isolation, each doing their own individual tasks. Now the work is more organized, and that's how we make it more efficient.”

Sentara is continuing to refine vertical care across all 17 of its emergency departments including updating the care spaces to best compliment the process.

“Overall, it’s a much happier place when we can keep things moving and people aren't here all day,” said Durkac.