From Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating Implementation of the Emergency Severity Index

2.50
Hdl Handle:
http://hdl.handle.net/10755/162579
Type:
Presentation
Title:
From Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating Implementation of the Emergency Severity Index
Abstract:
From Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating Implementation of the Emergency Severity Index
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Swailes, Eileen, RN
P.I. Institution Name:Good Samaritan Hospital Medical Center
Title:Assistant Nurse Manager
Contact Address:100 Montauk Highway, West Islip, NY, 11795, USA
Contact Telephone:631-376-4045
Leadership Conference - Research Abstract: From Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating Implementation of the Emergency Severity Index

Purpose: Pain is the most common reason for patient presentation at the emergency department; patients complaining of severe pain require prompt assessment and appropriate disposition. The Emergency Severity Index (ESI) triage system is a well documented, reliable and valid algorithm that streamlines the triage management process and efficiently directs patients to appropriate resources. The purpose of this study is to compare a previously used four-level triage system with the five-level ESI by examining the time from triage to treatment order and from triage to treatment administration for patients complaining of severe abdominal pain.

Design: Retrospective, descriptive with data derived from electronic medical records

Setting: 431-bed community hospital in the Northeastern United States

Subjects: The sample consisted of 684 electronic medical records for patients 18 years of age or older complaining of abdominal pain of intensity greater than or equal to 8 out of 10, ambulatory, awake, alert, oriented, and able to communicate at presentation to triage. Charts for patients with psychiatric diagnoses were excluded.

Methods: EMR data were extracted at three five-month intervals: prior to ESI implementation, during initial roll out, and after the addition of electronic medical record prompts.

Results: Although some demographic factors influenced time to treatment, implementation of the ESI had no effect on the overall time from triage to treatment order or to treatment administration in this sample. In the Pre-ESI period, 68% of patients complaining of severe abdominal pain were classified using the four-level triage scale as ôurgentö (similar to ESI level 2) with 32% assigned to ôurgent stableö category, which most closely corresponds to ESI level 3. Following implementation of the ESI triage system only 10% of patients complaining of severe abdominal pain were triaged to ESI level 2, with 90% assigned to ESI level 3. Patients classified to ESI level 2 received treatment significantly more quickly than those assigned to ESI level 3.

Implications: The operational challenges of instituting a new triage system must address staff buy in. Achieving staff engagement requires great care, strong leadership, and a significant amount of time in the pre-implementation phase. For systems to be successful, the key players must be fully engaged in execution of those systems. The ESI triage system is a viable tool for improvement of patient care in the emergency department however users must fully embrace this tool for it to be most beneficial.


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.titleFrom Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating Implementation of the Emergency Severity Indexen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162579-
dc.description.abstract<table><tr><td colspan="2" class="item-title">From Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating Implementation of the Emergency Severity Index</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">Swailes, Eileen, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Good Samaritan Hospital Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Nurse Manager</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">100 Montauk Highway, West Islip, NY, 11795, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">631-376-4045</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">eileen.swailes@chsli.org</td></tr><tr><td colspan="2" class="item-abstract">Leadership Conference - Research Abstract: From Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating Implementation of the Emergency Severity Index<br/><br/>Purpose: Pain is the most common reason for patient presentation at the emergency department; patients complaining of severe pain require prompt assessment and appropriate disposition. The Emergency Severity Index (ESI) triage system is a well documented, reliable and valid algorithm that streamlines the triage management process and efficiently directs patients to appropriate resources. The purpose of this study is to compare a previously used four-level triage system with the five-level ESI by examining the time from triage to treatment order and from triage to treatment administration for patients complaining of severe abdominal pain. <br/><br/>Design: Retrospective, descriptive with data derived from electronic medical records<br/><br/>Setting: 431-bed community hospital in the Northeastern United States<br/><br/>Subjects: The sample consisted of 684 electronic medical records for patients 18 years of age or older complaining of abdominal pain of intensity greater than or equal to 8 out of 10, ambulatory, awake, alert, oriented, and able to communicate at presentation to triage. Charts for patients with psychiatric diagnoses were excluded.<br/><br/>Methods: EMR data were extracted at three five-month intervals: prior to ESI implementation, during initial roll out, and after the addition of electronic medical record prompts. <br/><br/>Results: Although some demographic factors influenced time to treatment, implementation of the ESI had no effect on the overall time from triage to treatment order or to treatment administration in this sample. In the Pre-ESI period, 68% of patients complaining of severe abdominal pain were classified using the four-level triage scale as &ocirc;urgent&ouml; (similar to ESI level 2) with 32% assigned to &ocirc;urgent stable&ouml; category, which most closely corresponds to ESI level 3. Following implementation of the ESI triage system only 10% of patients complaining of severe abdominal pain were triaged to ESI level 2, with 90% assigned to ESI level 3. Patients classified to ESI level 2 received treatment significantly more quickly than those assigned to ESI level 3. <br/><br/>Implications: The operational challenges of instituting a new triage system must address staff buy in. Achieving staff engagement requires great care, strong leadership, and a significant amount of time in the pre-implementation phase. For systems to be successful, the key players must be fully engaged in execution of those systems. The ESI triage system is a viable tool for improvement of patient care in the emergency department however users must fully embrace this tool for it to be most beneficial.<br/><br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:30:34Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:34Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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