Triage Redesign: An Innovative Approach to Enhance Emergency Department Throughput

2.50
Hdl Handle:
http://hdl.handle.net/10755/162391
Type:
Presentation
Title:
Triage Redesign: An Innovative Approach to Enhance Emergency Department Throughput
Abstract:
Triage Redesign: An Innovative Approach to Enhance
Emergency Department Throughput
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:McRoy, Tonya, RN, BSN
P.I. Institution Name:Pitt County Memorial Hospital
Title:Nurse Manager
Contact Address:2100 Stantonsburg Road (ED), Greenville, NC, 27834, USA
Contact Telephone:252-847-1985
[ENA Annual Conference - Evidence-based Practice Presentation]

Purpose: Overcrowding in the Emergency Department lobby, extended wait times for the initial triage and room placement, serious safety events in the lobby, and low patient satisfaction scores were the driving forces behind the triage redesign. The purpose of the redesign was to optimize the triage process with a focus on throughput, patient safety, and patient satisfaction in the Emergency Department. Specific goals: (1) decrease the door to provider time, (2) decrease the number of patients who left without treatment (LWOT), (3) prevent serious safety events in the lobby, and (4) increase overall patient satisfaction.

Design: A departmental improvement process utilizing multidisciplinary resources to focus on staff development, awareness of patient safety in the lobby, and departmental throughput initiatives.

Setting: Rural academic medical center which serves 29 counties in Eastern North Carolina, Level 1 trauma center with 65,000 visits per year.

Participants: ED nursing staff and leadership, ancillary staff, Emergency Medicine Attending Physicians and Residents, and ED registration staff.

Method: ED leadership met to design a multidisciplinary Triage Team to view the current system and processes. Extensive literature reviews and team discussions occurred during the planning process. Process changes included: (1) relocation of the triage nurse to the lobby, (2) the implementation of portable radios to increase communication, (3) movement of registration staff to the lobby to expedite quick registration, (4) placement of patients in empty treatment rooms upon arrival bypassing the triage area, (5) placing a second nurse in the triage area when beds are not available and a more detailed triage is needed, and (6) redesign the lobby to accommodate patient flow. The Triage Team, along with different staff members, piloted the redesign by several small tests of change. The Team meets weekly to discuss ways to improve the process or to make changes to become more efficient. After each weekly meeting, information discussed during the meeting is posted in the department to update the entire staff.

Results: The redesign began in October, 2009. With no significant changes in volume over the three months prior and after the implementation, a significant reduction in the LWOT rate was quantified. From July, 2009 through December, 2009, the LWOT rate dropped from 2.0% to .7%. The lobby wait time decreased from an average of 30 minutes to 13 minutes. The continued education and team work of the front line staff has increased awareness and acceptance of change.

Implications: The Triage Redesign is a work in progress. A continued multidisciplinary approach will be essential to the growth and improvement of the redesign. This should continue to improve the patient care and the environment of care for both the patients and the care providers.
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.titleTriage Redesign: An Innovative Approach to Enhance Emergency Department Throughputen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162391-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Triage Redesign: An Innovative Approach to Enhance <br/>Emergency Department Throughput</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">McRoy, Tonya, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Pitt County Memorial Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2100 Stantonsburg Road (ED), Greenville, NC, 27834, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">252-847-1985</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">tmcroy@pcmh.com</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/><br/>Purpose: Overcrowding in the Emergency Department lobby, extended wait times for the initial triage and room placement, serious safety events in the lobby, and low patient satisfaction scores were the driving forces behind the triage redesign. The purpose of the redesign was to optimize the triage process with a focus on throughput, patient safety, and patient satisfaction in the Emergency Department. Specific goals: (1) decrease the door to provider time, (2) decrease the number of patients who left without treatment (LWOT), (3) prevent serious safety events in the lobby, and (4) increase overall patient satisfaction.<br/><br/>Design: A departmental improvement process utilizing multidisciplinary resources to focus on staff development, awareness of patient safety in the lobby, and departmental throughput initiatives. <br/><br/>Setting: Rural academic medical center which serves 29 counties in Eastern North Carolina, Level 1 trauma center with 65,000 visits per year.<br/><br/>Participants: ED nursing staff and leadership, ancillary staff, Emergency Medicine Attending Physicians and Residents, and ED registration staff.<br/><br/>Method: ED leadership met to design a multidisciplinary Triage Team to view the current system and processes. Extensive literature reviews and team discussions occurred during the planning process. Process changes included: (1) relocation of the triage nurse to the lobby, (2) the implementation of portable radios to increase communication, (3) movement of registration staff to the lobby to expedite quick registration, (4) placement of patients in empty treatment rooms upon arrival bypassing the triage area, (5) placing a second nurse in the triage area when beds are not available and a more detailed triage is needed, and (6) redesign the lobby to accommodate patient flow. The Triage Team, along with different staff members, piloted the redesign by several small tests of change. The Team meets weekly to discuss ways to improve the process or to make changes to become more efficient. After each weekly meeting, information discussed during the meeting is posted in the department to update the entire staff. <br/><br/>Results: The redesign began in October, 2009. With no significant changes in volume over the three months prior and after the implementation, a significant reduction in the LWOT rate was quantified. From July, 2009 through December, 2009, the LWOT rate dropped from 2.0% to .7%. The lobby wait time decreased from an average of 30 minutes to 13 minutes. The continued education and team work of the front line staff has increased awareness and acceptance of change. <br/><br/>Implications: The Triage Redesign is a work in progress. A continued multidisciplinary approach will be essential to the growth and improvement of the redesign. This should continue to improve the patient care and the environment of care for both the patients and the care providers. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:24Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:24Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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