2.50
Hdl Handle:
http://hdl.handle.net/10755/162565
Type:
Presentation
Title:
Hurry, Hurry, Hurry - Rapid Triage to Speed Up the System
Abstract:
Hurry, Hurry, Hurry - Rapid Triage to Speed Up the System
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Doyle, Stacy, RN, MBA, CPN
P.I. Institution Name:Children's Mercy Hospitals and Clinics
Title:Emergency Department Manager
Contact Address:2401 Gilham Road, Kansas City, MO, 64108, USA
Contact Telephone:816-983-6281
Co-Authors:Jennifer Kingsnorth, RN, MSN; Cathie E. Guzzetta, RN, PhD, AHN-BC, FAAN; Sara A. Pyle, PhD
Leadership Conference - Research Abstract: Hurry, Hurry, Hurry- Rapid Triage to Speed Up the System

Purpose: The aim of the process change presented was to decrease emergency department (ED) arrival-to-triage times, left without treatment rates and increase fast track utilization through the implementation of a rapid triage system with fast track guidelines.

Design: The project observed the outcomes cross-sectionally pre and post implementation

Setting: Study took place in a pediatric, academic, level 1 trauma center emergency department.

Participants/Subjects: Data was collected from the population of patients entering the ED during the data collection periods. For arrival-to-triage, data was collected one month pre and pone month post implementation. Left without being seen and fast track utilization were assessed for 10 months pre and post implementation.

Methods: Pre-implementation patients arrived to the ED and checked in with a registration clerk and were then queued for triage. Wait time at triage could be up to 4 hours. Acuity was set with a "home-grown" five-level system with no validity or reliability and was based on a loose set of guidelines, provider preference and experience, and the state of the ED at the time. Patients were assigned to fast track and ED in an inconsistent way based on provider and nurse preferences. The system intervention involved using the emergency severity index (ESI) acuity system that has been validated and found reliable in adult populations, implementation of a rapid triage assessment where the patient is evaluated and classified immediately upon arrival, and implementation of fast track guidelines. Fast track utilization, and left without being seen rates were measured for all patients/families in the pre-implementation (n = 60,373) and post-implementation (n = 67,939) groups. Evaluation of arrival-to-triage included all patients presenting to the emergency department for one month pre-implementation and the same month post-implementation (n=13,910).

Results/Outcomes: Post-intervention patients/families experienced significantly decreased arrival-to-triage times compared to pre-intervention (p<.001) with most patients (88.3%) being triaged less than 10 minutes after implementation of rapid triage. Following implementation of fast track guidelines, patients were 14% more likely to be sent to fast track; those with the lowest acuity were nearly 50% more likely to be sent to fast track than pre-intervention. Although the left without being seen rates did not change, overall acuity level was lower in post-intervention patients. While left without being seen rates did not decrease with intervention, implementation of rapid triage and fast track guidelines reduced arrival-to-triage times and decreased acuity in the left without being seen population.

Implications: These findings indicate that implementing rapid triage and fast track guidelines can impact nurse sensitive patient outcomes related to safety and care delivery in a pediatric emergency department. Further interventions are warranted for decreasing left without being seen rates.



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.titleHurry, Hurry, Hurry - Rapid Triage to Speed Up the Systemen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162565-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Hurry, Hurry, Hurry - Rapid Triage to Speed Up the System</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">Doyle, Stacy, RN, MBA, CPN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Children's Mercy Hospitals and Clinics</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Emergency Department Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2401 Gilham Road, Kansas City, MO, 64108, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">816-983-6281</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">sdoyle@cmh.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Jennifer Kingsnorth, RN, MSN; Cathie E. Guzzetta, RN, PhD, AHN-BC, FAAN; Sara A. Pyle, PhD</td></tr><tr><td colspan="2" class="item-abstract">Leadership Conference - Research Abstract: Hurry, Hurry, Hurry- Rapid Triage to Speed Up the System<br/><br/>Purpose: The aim of the process change presented was to decrease emergency department (ED) arrival-to-triage times, left without treatment rates and increase fast track utilization through the implementation of a rapid triage system with fast track guidelines.<br/><br/>Design: The project observed the outcomes cross-sectionally pre and post implementation<br/><br/>Setting: Study took place in a pediatric, academic, level 1 trauma center emergency department. <br/><br/>Participants/Subjects: Data was collected from the population of patients entering the ED during the data collection periods. For arrival-to-triage, data was collected one month pre and pone month post implementation. Left without being seen and fast track utilization were assessed for 10 months pre and post implementation.<br/><br/>Methods: Pre-implementation patients arrived to the ED and checked in with a registration clerk and were then queued for triage. Wait time at triage could be up to 4 hours. Acuity was set with a &quot;home-grown&quot; five-level system with no validity or reliability and was based on a loose set of guidelines, provider preference and experience, and the state of the ED at the time. Patients were assigned to fast track and ED in an inconsistent way based on provider and nurse preferences. The system intervention involved using the emergency severity index (ESI) acuity system that has been validated and found reliable in adult populations, implementation of a rapid triage assessment where the patient is evaluated and classified immediately upon arrival, and implementation of fast track guidelines. Fast track utilization, and left without being seen rates were measured for all patients/families in the pre-implementation (n = 60,373) and post-implementation (n = 67,939) groups. Evaluation of arrival-to-triage included all patients presenting to the emergency department for one month pre-implementation and the same month post-implementation (n=13,910). <br/><br/>Results/Outcomes: Post-intervention patients/families experienced significantly decreased arrival-to-triage times compared to pre-intervention (p&lt;.001) with most patients (88.3%) being triaged less than 10 minutes after implementation of rapid triage. Following implementation of fast track guidelines, patients were 14% more likely to be sent to fast track; those with the lowest acuity were nearly 50% more likely to be sent to fast track than pre-intervention. Although the left without being seen rates did not change, overall acuity level was lower in post-intervention patients. While left without being seen rates did not decrease with intervention, implementation of rapid triage and fast track guidelines reduced arrival-to-triage times and decreased acuity in the left without being seen population.<br/><br/>Implications: These findings indicate that implementing rapid triage and fast track guidelines can impact nurse sensitive patient outcomes related to safety and care delivery in a pediatric emergency department. Further interventions are warranted for decreasing left without being seen rates.<br/><br/><br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:20Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:20Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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