Emergency Department

The Emergency Department (ED) has a staff of emergency physicians on duty 24 hours a day. The ED is designed to provide immediate medical care to individuals with threat to life or limb, stabilizing the emergency as much as possible, and providing medically indicated services to any patient that presents to the ED. The ED utilizes Telehealth technology for certain patient populations.  

The ED is an “Alternative Destination Receiving Facility” for ambulances.  Patients who do not meet Alternative Destination criteria are transported to the closest facility for treatment.  Only patients who self-identify as a “Veteran” will be transported to the VANHS ED for emergency treatment.  

Patients arriving by ambulance will be triaged by the charge nurse or designee according to the Agency for Healthcare Research and Quality (AHRQ) 5 Level Emergency Severity Index (ESI) Triage system.  Patients who are categorized as ESI IV or V will be escorted to enrollment window.  Patients who are categorized as ESI II or III will be direct bedded if beds are available in the main ED.  Patients arriving by ambulance will be entered into the Emergency Information Management System (EDIS) and placed on the locator board by the Health Administrative Services (HAS) Program Support Assistant (PSA). 

Patients arriving in the ED via ambulatory means will be directed to the triage area by the enrollment staff once entered into EDIS and  placed on the locator board.  A “First look” triage assessment will be conducted by an ED Registered Nurse. The priority in which a patient is assessed will be determined by the degree of urgency, not necessarily by order of arrival.

VASNHS has adopted the AHRQ 5 Level Emergency Severity Index (ESI) triage system, which is endorsed by the Emergency Nurses Association (ENA) and American College of Emergency Physicians (ACEP). Triaging of all patients will be documented in CPRS using a five-level priority triage system. 

Patients are triaged based on medical severity with Emergency Severity Index (ESI) Level: 

• I. Resuscitation
• II. Emergent
• III. Urgent
• IV. Non-Urgent
• V. Routine or Referred

During peak volume times, Monday through Friday, an ED  provider may be assigned to the triage area to implement a Rapid Medical Evaluation (RME) Process. Patients are evaluated in the triage area by this medical provider from the lobby. The care of the patient is facilitated; and orders are initiated.

During peak volume times, Monday through Friday, patients with an ESI level of IV or V will be triaged by the “First look” nurse, then directed to the fast-track area where they will be evaluated and treated by an ED Physician Assistant, ED Nurse Practitioner, or an ED Physician.