2.50
Hdl Handle:
http://hdl.handle.net/10755/162364
Type:
Presentation
Title:
Rapid Triage-The Golden Minute
Abstract:
Rapid Triage-The Golden Minute
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Blankenship, Beth L., RN, BSN, MSHA
P.I. Institution Name:Parham Doctors Hospital
Title:Director of Emergency Services
Contact Address:7700 E. Parham Road, Richmond, VA, 23294, USA
Contact Telephone:804-967-5244
Co-Authors:Sheldon Maguire, RN, MSN, ACNP
[ENA Annual Conference - Evidence-based Practice Presentation]

Purpose: Layered expectations of the triage nurse have impacted efficiency contributing to prolonged greet times, decreased patient satisfaction and potential adverse effects on the overall quality of clinical care. Nationally, emergency department risk management claims continue to result from overcrowding and patient holds which are known barriers to initiation of timely care delivery. Rapid triage performed in less than 60 seconds by a registered nurse was identified as a way to reestablish the immediacy of initial assessment to patients presenting to the emergency department.

Design: Evidence based quality assurance initiative designed to effectively manage volume growth, promote patient safety, improve throughput and increase overall satisfaction for all patients seeking care.

Setting: Community based emergency department in suburban area with 18 beds.

Participants/Subjects: All persons presenting to the Emergency Department for treatment, excluding those who arrived by Emergency Medical Services.

Methods: Through observations and metric reports, it was noted that patients may be in the ED for 10 minutes or more before being seen by the triage nurse. In addition, it was also noted that the triage nurse was performing a comprehensive assessment as opposed to rapid triage to determine level of acuity.

The process for walk-in patients and initial documentation elements was revised. The first change involved the reception of patients, making the nurse the first point of contact when patients arrived. Documentation elements were modified to capture chief complaint, associated symptoms, pertinent medical history, ABC's, allergies, vital signs, and pregnancy status.

Two additional process changes included: physically relocating the nurse to the reception desk within the waiting area and the addition of a paramedic or second nurse during peak arrival times.

Key metrics used for reporting results on this project are defined as follows: Arrive to triage is the interval between patient arrival time and time of triage (goal <10 min); Arrive to greet is the interval between patient arrival time and time they are greeted by a provider (goal <45 min); Arrive to leave is the interval between patient arrival time and time they leave the department (goal <150 min); Left prior to triage/medical screening exam (L/L) is the total percentage of patients who leave prior to triage or medical screening examination (goal <1.5%); and patient satisfaction score is the overall satisfaction as reported by Gallup (goal 5.0).

Results/Outcomes: Metric improvements were achieved across all measure sets. Over the course of one year, arrive to triage time decreased from 2.6 minutes to 0.86 minutes, contributing to lower greet times and an overall length of stay of less than 150 minutes. Patients who left prior to medical screening decreased by almost 50% and patient satisfaction rose, even amidst the challenges of increased volumes.

Implications: Rapid triage is an effective process that enhances throughput and improves patient satisfaction. Decreased ED wait times have been identified as a key strategy to ensure patient safety and quality of care. Modification to one process resulted in more timely delivery of clinical care while creating additional capacity.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleRapid Triage-The Golden Minuteen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162364-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Rapid Triage-The Golden Minute</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Blankenship, Beth L., RN, BSN, MSHA</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Parham Doctors Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director of Emergency Services</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">7700 E. Parham Road, Richmond, VA, 23294, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">804-967-5244</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">beth.lombardo@hcahealthcare.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Sheldon Maguire, RN, MSN, ACNP</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/><br/>Purpose: Layered expectations of the triage nurse have impacted efficiency contributing to prolonged greet times, decreased patient satisfaction and potential adverse effects on the overall quality of clinical care. Nationally, emergency department risk management claims continue to result from overcrowding and patient holds which are known barriers to initiation of timely care delivery. Rapid triage performed in less than 60 seconds by a registered nurse was identified as a way to reestablish the immediacy of initial assessment to patients presenting to the emergency department.<br/><br/>Design: Evidence based quality assurance initiative designed to effectively manage volume growth, promote patient safety, improve throughput and increase overall satisfaction for all patients seeking care.<br/><br/>Setting: Community based emergency department in suburban area with 18 beds. <br/><br/>Participants/Subjects: All persons presenting to the Emergency Department for treatment, excluding those who arrived by Emergency Medical Services. <br/><br/>Methods: Through observations and metric reports, it was noted that patients may be in the ED for 10 minutes or more before being seen by the triage nurse. In addition, it was also noted that the triage nurse was performing a comprehensive assessment as opposed to rapid triage to determine level of acuity. <br/><br/>The process for walk-in patients and initial documentation elements was revised. The first change involved the reception of patients, making the nurse the first point of contact when patients arrived. Documentation elements were modified to capture chief complaint, associated symptoms, pertinent medical history, ABC's, allergies, vital signs, and pregnancy status. <br/><br/>Two additional process changes included: physically relocating the nurse to the reception desk within the waiting area and the addition of a paramedic or second nurse during peak arrival times. <br/><br/>Key metrics used for reporting results on this project are defined as follows: Arrive to triage is the interval between patient arrival time and time of triage (goal &lt;10 min); Arrive to greet is the interval between patient arrival time and time they are greeted by a provider (goal &lt;45 min); Arrive to leave is the interval between patient arrival time and time they leave the department (goal &lt;150 min); Left prior to triage/medical screening exam (L/L) is the total percentage of patients who leave prior to triage or medical screening examination (goal &lt;1.5%); and patient satisfaction score is the overall satisfaction as reported by Gallup (goal 5.0).<br/><br/>Results/Outcomes: Metric improvements were achieved across all measure sets. Over the course of one year, arrive to triage time decreased from 2.6 minutes to 0.86 minutes, contributing to lower greet times and an overall length of stay of less than 150 minutes. Patients who left prior to medical screening decreased by almost 50% and patient satisfaction rose, even amidst the challenges of increased volumes. <br/><br/>Implications: Rapid triage is an effective process that enhances throughput and improves patient satisfaction. Decreased ED wait times have been identified as a key strategy to ensure patient safety and quality of care. Modification to one process resulted in more timely delivery of clinical care while creating additional capacity. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:26:55Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:26:55Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.