2.50
Hdl Handle:
http://hdl.handle.net/10755/162495
Type:
Presentation
Title:
Triage Transformation Project - Implementation of Triage Best Practices
Abstract:
Triage Transformation Project - Implementation of Triage Best Practices
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Bain, Jessica, RN, FN, BSN, CEN
P.I. Institution Name:Naval Hospital Bremerton
Title:Division Officer/Nurse Manager Emergency Department
Contact Address:One Boone Road, Bremerton, WA, 98312-1898
Contact Telephone:360-475-4286
[Leadership Conference Poster Presentation] Purpose: There are five "Best Practices" of triage set forth by the emergency community that were not met in our emergency department. A process improvement project was initiated in an effort to meet those best practices.

Design: The project encompassed staff development and process/system updates.

Setting: A medium sized military family medicine teaching facility.

Participants/Subjects: Data was collected regarding all patients that reported to the emergency department for treatment from 2005 to present. All registered nurses working in the emergency department participated.

Methods: To meet the community standards for triage the emergency department developed and began implementation of a "Triage Transformation Program". The five "Best Practices" were identified as: 1) utilization of the five level Emergency Severity Index (ESI) Triage system, 2) registered nurses only performing triage, 3) formalized triage education for the nurses performing triage, 4) focused triage with standing orders, and 5) computerized charting. Since the initial phase of implementation in 2005, data was gathered and analyzed on "Door to Doctor" time, Length of Stay (LOS), and number of patients who Left without Being Seen (LWBS).

Results: Implementation resulting in a decrease in the "Door to Doctor" time for all ESI 2 (Urgent - with three level triage system) and ESI 3 (Non-urgent with 3 Level triage system) and an overall decrease in "Door to Doctor" time for all patients despite the loss of a secondary provider in 2008. The most significant decrease was seen in the ESI 3 from nearly 70 minutes to 40 minutes or less. The average Length of Stay for all patient triage categories remained the same, however the length of stay for the ESI 4 and ESI 5 significantly decreased with ESI 5 patients Length of Stay less than 100 minutes. The number of patients who LWBS, was also reduced. In addition, the number that left without being triaged showed a steady decline. Implementation of computerized charting and developing "nurse first" triage versus clerk first visualization are still in development.

Recommendations: Triage is a dynamic and crucial element of emergency care, with a direct effect on patient outcomes and overwhelming potential for litigation. Therefore, it is imperative that triage be a priority for emergency departments. Several ideas are still being considered, such as adding and additional triage nurse for peak hours/seasons, a nurse/provider team for triage during peak hours, reinstating the "fast track" and reconsidering the need for a full set of vital signs on every patient. With the current military deployment tempo and fiscal constraints it is not feasible to implement solutions that require additional staff. The nursing staff appreciated the formalized training in triage, the autonomy of standing orders, the simplicity of the ESI triage system and the recognition of triage as a keenly developed skill that requires experience and expertise in emergency nursing.
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 Transformation Project - Implementation of Triage Best Practicesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162495-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Triage Transformation Project - Implementation of Triage Best Practices</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">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Bain, Jessica, RN, FN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Naval Hospital Bremerton</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Division Officer/Nurse Manager Emergency Department</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">One Boone Road, Bremerton, WA, 98312-1898</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">360-475-4286</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jessica.bain@med.navy.mil</td></tr><tr><td colspan="2" class="item-abstract">[Leadership Conference Poster Presentation] Purpose: There are five &quot;Best Practices&quot; of triage set forth by the emergency community that were not met in our emergency department. A process improvement project was initiated in an effort to meet those best practices.<br/><br/>Design: The project encompassed staff development and process/system updates.<br/><br/>Setting: A medium sized military family medicine teaching facility.<br/><br/>Participants/Subjects: Data was collected regarding all patients that reported to the emergency department for treatment from 2005 to present. All registered nurses working in the emergency department participated.<br/><br/>Methods: To meet the community standards for triage the emergency department developed and began implementation of a &quot;Triage Transformation Program&quot;. The five &quot;Best Practices&quot; were identified as: 1) utilization of the five level Emergency Severity Index (ESI) Triage system, 2) registered nurses only performing triage, 3) formalized triage education for the nurses performing triage, 4) focused triage with standing orders, and 5) computerized charting. Since the initial phase of implementation in 2005, data was gathered and analyzed on &quot;Door to Doctor&quot; time, Length of Stay (LOS), and number of patients who Left without Being Seen (LWBS).<br/><br/>Results: Implementation resulting in a decrease in the &quot;Door to Doctor&quot; time for all ESI 2 (Urgent - with three level triage system) and ESI 3 (Non-urgent with 3 Level triage system) and an overall decrease in &quot;Door to Doctor&quot; time for all patients despite the loss of a secondary provider in 2008. The most significant decrease was seen in the ESI 3 from nearly 70 minutes to 40 minutes or less. The average Length of Stay for all patient triage categories remained the same, however the length of stay for the ESI 4 and ESI 5 significantly decreased with ESI 5 patients Length of Stay less than 100 minutes. The number of patients who LWBS, was also reduced. In addition, the number that left without being triaged showed a steady decline. Implementation of computerized charting and developing &quot;nurse first&quot; triage versus clerk first visualization are still in development. <br/><br/>Recommendations: Triage is a dynamic and crucial element of emergency care, with a direct effect on patient outcomes and overwhelming potential for litigation. Therefore, it is imperative that triage be a priority for emergency departments. Several ideas are still being considered, such as adding and additional triage nurse for peak hours/seasons, a nurse/provider team for triage during peak hours, reinstating the &quot;fast track&quot; and reconsidering the need for a full set of vital signs on every patient. With the current military deployment tempo and fiscal constraints it is not feasible to implement solutions that require additional staff. The nursing staff appreciated the formalized training in triage, the autonomy of standing orders, the simplicity of the ESI triage system and the recognition of triage as a keenly developed skill that requires experience and expertise in emergency nursing.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:29:10Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:10Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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