Task-oriented vs. Goal-oriented: A New Paradigm for "Rooming" Patients

INTRODUCTIONIn the fast-paced setting of the Emergency Department (ED), efficiency is important to delivering timely, effective care. A key aspect of this involves preparing patients by providing hospital gowns and connecting them to cardiac/vital signs monitors. These seemingly basic steps are crucial for ensuring patient safety and streamlining the providers evaluation process. However, in the ED, patients are often not fully prepared before a provider enters the room, leading to delays and inefficiencies. This study examines the rates at which patients are properly gowned and monitored upon rooming, to identify areas where ED workflows can be optimized to improve care delivery and better utilize staff and resources. MATERIALS AND METHODSThe study was conducted in the adult Emergency Department at Long Island Jewish Medical Center. Data were collected from 100 randomly selected patients between June and October 2024. Patients were excluded if they wore loose-fitting clothing that allowed easy access to the area being evaluated, or if their chief complaint involved a visibly accessible body part (e.g., face), eliminating the need for disrobing or monitoring. The need for a hospital gown or connection to a cardiac/vital signs monitor was determined based on standard triage criteria, such as cardiopulmonary symptoms or the need to examine areas not easily accessible through clothing. We measured the percentage of patients who were appropriately gowned or monitored prior to the provider entering the room. RESULTSOf the 100 patients, 89 required a hospital gown, but only 61 (69%) received one. Regarding cardiac monitoring, 46 patients required a monitor, but only 20 (43%) were connected to one. In 50% of cases, patients had the correct body part exposed for examination before the providers arrival. CONCLUSIONThis study highlights significant inefficiencies in patient preparation in the ED, specifically related to gowning and cardiac monitoring. While 89% of patients required a gown, only 69% had one before the providers arrival. Similarly, only 43% of the patients who required monitoring were appropriately connected to a monitor. Additionally, only half of the patients had the correct body parts exposed for examination. These gaps in preparation force providers to complete these tasks themselves, contributing to delays, increasing provider workload, and potentially leading to burnout. To address this, we recommend shifting from task-oriented to goal-oriented patient rooming, revising protocols, and implementing checklists. These changes could help optimize resource use, reduce delays, and improve overall efficiency.