2.50
Hdl Handle:
http://hdl.handle.net/10755/162433
Type:
Presentation
Title:
Improving Quality in the ED with a Triage Care Team
Abstract:
Improving Quality in the ED with a Triage Care Team
Conference Sponsor:Emergency Nurses Association
Conference Year:2011
Author:Klausing, Barbara, RN-C, BSN
P.I. Institution Name:Baylor Medical Center at Irving
Title:Director of Emergency Services
Contact Address:1901 N. MacArthur Blvd., Irving, TX, 75061, USA
Contact Telephone:972-579-5328
Co-Authors:Cherl Phillips, RN, BSN, CEN
[ENA Leadership Conference] Evidence-based Practice Presentation: Improving Quality in the ED with a Triage Care Team

Purpose: A rapid cycle improvement project in the emergency department (ED) two years ago decreased the door to provider times from almost 80 minutes to below 45. Efforts using strategies developed were not effective to reduce the times below the 30 minute goal with a plateau averaging 40 minutes. Left without being seen (LWBS) rates January through November 2009 averaged 3.65% with a high of 5.5%. Decreased door to provider times facilitate evaluation and treatment, increasing quality and safety for patients. Decreased door to provider times also decrease the LWBS; all patients that leave are at risk. Initiation of a Rapid Medical Evaluation (RME) process was implemented in the spring of 2009 but the door to provider times still did not decrease as hoped. To achieve the goal of providing high quality care in the most efficient, expeditious manner possible, and meet the door to provider goal of less than 30 minutes, processes would still need to be modified.

Design: A multidisciplinary team was formed as a quality improvement project for rapid cycle improvement.

Setting: The facility is a not-for-profit 288 bed hospital with a 34 bed acute care Emergency Department with over 60,000 visits annually in an urban area of Texas.

Participants: The multidisciplinary team consists of senior nursing leadership, nursing supervisors, ED medical staff, nurses, registration, lab and radiology staff.

Methods: In December 2009, a team was formed to revise the RME process and proposed a modified Rapid Medical Assessment (RMA) with a team of a provider, RN, and ED tech stationed at triage. After triage, the physician or midlevel completes an assessment, often without the patient leaving the initial triage area. The physician or midlevel at triage initiates orders which include medications, lab and radiology testing. Until beds are available, patients in various stages of testing and care are returned to the ED lobby. Low acuity patients may be treated and discharged directly from the triage area. The process was trialed intermittently the last half of December and put in place 12 hours per day starting January 1, 2010. The team initially met weekly to address issues and modify process as needed. The roles and responsibilities of the RN and ED tech at triage were outlined and modified several times for efficiency and patient flow.

Results/Outcomes: During the initial trial, December door to doctor time decreased to an average of 28 minutes, and left without being seen (LWOBS) rate to 1.7%. January door to doctor time averaged 21 minutes with LWOBS at 2.0%. June door to provider time averaged 18 minutes with LWBS of 2.1%.

Implications: A sustained decreased door to provider time has led to decreased LWOBS rate. This process has facilitated the testing and treatment of the patients and has improved the quality of care.
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.titleImproving Quality in the ED with a Triage Care Teamen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162433-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving Quality in the ED with a Triage Care Team</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">2011</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Klausing, Barbara, RN-C, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Baylor Medical Center at Irving</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">1901 N. MacArthur Blvd., Irving, TX, 75061, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">972-579-5328</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">barbark@baylorhealth.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Cherl Phillips, RN, BSN, CEN</td></tr><tr><td colspan="2" class="item-abstract">[ENA Leadership Conference] Evidence-based Practice Presentation: Improving Quality in the ED with a Triage Care Team<br/><br/>Purpose: A rapid cycle improvement project in the emergency department (ED) two years ago decreased the door to provider times from almost 80 minutes to below 45. Efforts using strategies developed were not effective to reduce the times below the 30 minute goal with a plateau averaging 40 minutes. Left without being seen (LWBS) rates January through November 2009 averaged 3.65% with a high of 5.5%. Decreased door to provider times facilitate evaluation and treatment, increasing quality and safety for patients. Decreased door to provider times also decrease the LWBS; all patients that leave are at risk. Initiation of a Rapid Medical Evaluation (RME) process was implemented in the spring of 2009 but the door to provider times still did not decrease as hoped. To achieve the goal of providing high quality care in the most efficient, expeditious manner possible, and meet the door to provider goal of less than 30 minutes, processes would still need to be modified. <br/><br/>Design: A multidisciplinary team was formed as a quality improvement project for rapid cycle improvement.<br/><br/>Setting: The facility is a not-for-profit 288 bed hospital with a 34 bed acute care Emergency Department with over 60,000 visits annually in an urban area of Texas.<br/><br/>Participants: The multidisciplinary team consists of senior nursing leadership, nursing supervisors, ED medical staff, nurses, registration, lab and radiology staff.<br/><br/>Methods: In December 2009, a team was formed to revise the RME process and proposed a modified Rapid Medical Assessment (RMA) with a team of a provider, RN, and ED tech stationed at triage. After triage, the physician or midlevel completes an assessment, often without the patient leaving the initial triage area. The physician or midlevel at triage initiates orders which include medications, lab and radiology testing. Until beds are available, patients in various stages of testing and care are returned to the ED lobby. Low acuity patients may be treated and discharged directly from the triage area. The process was trialed intermittently the last half of December and put in place 12 hours per day starting January 1, 2010. The team initially met weekly to address issues and modify process as needed. The roles and responsibilities of the RN and ED tech at triage were outlined and modified several times for efficiency and patient flow.<br/> <br/>Results/Outcomes: During the initial trial, December door to doctor time decreased to an average of 28 minutes, and left without being seen (LWOBS) rate to 1.7%. January door to doctor time averaged 21 minutes with LWOBS at 2.0%. June door to provider time averaged 18 minutes with LWBS of 2.1%. <br/><br/>Implications: A sustained decreased door to provider time has led to decreased LWOBS rate. This process has facilitated the testing and treatment of the patients and has improved the quality of care. <br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:28:08Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:28:08Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.