2.50
Hdl Handle:
http://hdl.handle.net/10755/162542
Type:
Presentation
Title:
Changing the Triage Process to Decrease Length of Stay
Abstract:
Changing the Triage Process to Decrease Length of Stay
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:Sanchez, Debbie, RN, BSN, CEN
P.I. Institution Name:Providence St. Vincent Hospital
Title:RN
Contact Address:9205 SW Barnes Road, Portland, OR, 97225, USA
Contact Telephone:503-216-2361
Co-Authors:Ann Bufkin, RN, BSN, CEN; Lara Busch, RN, CEN, ADN; Tracey Moore, RN, ADN; Brenda McPherson, RN, BSN, CEN; Kaylee Alberts, RN, BSN; Heidi Lindner, RN, BSN, CCRN, CEN, SANE; Adrienne Jones, RN, ADN; Constance Rogin; Michael Flynn; Barb Reilly
[Annual Conference] Clinical Topic: Our clinical project was to improve our triage process. We established a core group of expert emergency triage nurses to evaluate our current process entitled Project One. During this project the group identified multiple problems. Patients were waiting in the triage lobby for up to 4 hours without registration or receiving treatment and 3.8% of the waiting patients left without being seen.
Our group decided to focus on one major goal: Every patient is triaged and diagnostics or nursing treatment will be initiated within 30 minutes of presenting to the ED.

Our objectives were:
1. No patient will leave without being seen by an Emergency Department MD or NP.
2. Patients will be registered within 30 minutes of arrival.
3. Nurse initiated orders will be implemented within 30 minutes of arrival.

Implementation: The plan of action was to improve customer service, increase accountability, redefine roles and educate staff. In an 8-hour work out session, the Project One group reviewed evidence based literature, investigated other proven triage practices in the medical community and compared those findings with the current practice in our facility.
The process was improved using the Lean method. Lean defines what is valued by the patient, identifies waste, standardizes processes and the physical environment, and encourages a culture of continuous improvement.
The triage process was evaluated using a value stream map. A Kaizen team developed a work plan to implement the recommended improvements. Registration was moved to the lobby, a standard for the triage process was specified, and staff roles were clearly defined. Implementation involved a go live demonstration of the changes. Specially educated core staff agreed to work at triage for 30 days in order to implement the changes. Their commitment to this work reduced variability in the process allowing the group to accurately measure performance.

Outcomes: Total patient process in the lobby pre Kaizen was 105.8 minutes. After the Kaizen the time improved to 42.2 minutes. This improvement is a 60% reduction in patients waiting for diagnostics and treatment. 98% of patients are now triaged within 30 minutes of arrival and the mean time to triage is 8 minutes. Decreased variability in process resulted in improved patient flow and increased patient and staff satisfaction. Patients with Nurse Initiated Orders at Triage spend an average of 30 min less in an ED bed: that portion of total length of stay decreased from 149 minutes to 119 minutes. (P value = 0.000).

Recommendations: This project is relevant to every ED in the nation because of overcrowding. Evaluation of current ED process and education of staff can significantly impact patient length of stay, patient and staff satisfaction, and patient safety. It is important to publish results and to improve knowledge and clinical 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.titleChanging the Triage Process to Decrease Length of Stayen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162542-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Changing the Triage Process to Decrease Length of Stay</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">Sanchez, Debbie, RN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Providence St. Vincent Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">RN</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">9205 SW Barnes Road, Portland, OR, 97225, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">503-216-2361</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Debbie.Sanchez@providence.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Ann Bufkin, RN, BSN, CEN; Lara Busch, RN, CEN, ADN; Tracey Moore, RN, ADN; Brenda McPherson, RN, BSN, CEN; Kaylee Alberts, RN, BSN; Heidi Lindner, RN, BSN, CCRN, CEN, SANE; Adrienne Jones, RN, ADN; Constance Rogin; Michael Flynn; Barb Reilly</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference] Clinical Topic: Our clinical project was to improve our triage process. We established a core group of expert emergency triage nurses to evaluate our current process entitled Project One. During this project the group identified multiple problems. Patients were waiting in the triage lobby for up to 4 hours without registration or receiving treatment and 3.8% of the waiting patients left without being seen. <br/> Our group decided to focus on one major goal: Every patient is triaged and diagnostics or nursing treatment will be initiated within 30 minutes of presenting to the ED. <br/><br/>Our objectives were:<br/>1. No patient will leave without being seen by an Emergency Department MD or NP. <br/>2. Patients will be registered within 30 minutes of arrival. <br/>3. Nurse initiated orders will be implemented within 30 minutes of arrival. <br/><br/>Implementation: The plan of action was to improve customer service, increase accountability, redefine roles and educate staff. In an 8-hour work out session, the Project One group reviewed evidence based literature, investigated other proven triage practices in the medical community and compared those findings with the current practice in our facility. <br/> The process was improved using the Lean method. Lean defines what is valued by the patient, identifies waste, standardizes processes and the physical environment, and encourages a culture of continuous improvement. <br/>The triage process was evaluated using a value stream map. A Kaizen team developed a work plan to implement the recommended improvements. Registration was moved to the lobby, a standard for the triage process was specified, and staff roles were clearly defined. Implementation involved a go live demonstration of the changes. Specially educated core staff agreed to work at triage for 30 days in order to implement the changes. Their commitment to this work reduced variability in the process allowing the group to accurately measure performance. <br/><br/>Outcomes: Total patient process in the lobby pre Kaizen was 105.8 minutes. After the Kaizen the time improved to 42.2 minutes. This improvement is a 60% reduction in patients waiting for diagnostics and treatment. 98% of patients are now triaged within 30 minutes of arrival and the mean time to triage is 8 minutes. Decreased variability in process resulted in improved patient flow and increased patient and staff satisfaction. Patients with Nurse Initiated Orders at Triage spend an average of 30 min less in an ED bed: that portion of total length of stay decreased from 149 minutes to 119 minutes. (P value = 0.000).<br/><br/>Recommendations: This project is relevant to every ED in the nation because of overcrowding. Evaluation of current ED process and education of staff can significantly impact patient length of stay, patient and staff satisfaction, and patient safety. It is important to publish results and to improve knowledge and clinical expertise in emergency nursing.</td></tr></table>en_GB
dc.date.available2011-10-27T10:29:57Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:29:57Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.