2.50
Hdl Handle:
http://hdl.handle.net/10755/162685
Type:
Presentation
Title:
Triage: Innovative Process Redesign Exceeds Outcome Expectations
Abstract:
Triage: Innovative Process Redesign Exceeds Outcome Expectations
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Carlen-Lindauer, Cathleen, RN, MSN, CEN
P.I. Institution Name:Johns Hopkins Hospital
Contact Address:, Baltimore, MD, 21297-, USA
Contact Telephone:(410) 955-4622
Purpose: Emergency Department overcrowding, long wait times for care, patients leaving the ED without provider evaluation, and low patient satisfaction scores prompted a need for redesign an antiquated triage system. The purpose of this project was to redesign the triage system to improve its efficiency and optimize patient flow. Specifically, the goals were: (1) Decrease "patient arrival to seen by provider" times; (2) decrease number of LWBE (left without being evaluated) patients; (3) increase patient satisfaction score for "waiting time to treatment area" and "waiting time to provider".

Design: This project is a patient safety and internal process improvement initiative.

Setting: Mid-Atlantic urban academic center, Level I Trauma Center with 65,000 visits per year.

Participants: All Nursing staff, faculty, residents, and mid-level providers in the Adult Emergency Department

Methods: Emergency Department executive leadership initiated a multidisciplinary taskforce to review current system utilization and redesign patient triage and evaluation. Process changes included: (1) Instituting 5-level Emergency Severity Index (ESI) triage system using a two-tiered triage process (2) Immediately assigning the patient to a provider team (3) Utilizing ESI as framework for patient throughput (4) Initiating patient evaluation by a provider at triage (5) Accommodating patient flow by redesigning facility (physical site plan).
Taskforce members piloted the new system to identify issues and obstacles that might impede the implementation. This new process began on January 31, 2006. The Variables measured six months before and after intervention: percentage of patients leaving without complete evaluation, time to provider and patient satisfaction data.

Results: Patient satisfaction data had the most unexpected improvement in this project. Overall patient satisfaction increased by 7.5 points. Focused satisfaction for "waiting time to treatment" increased by 16.5 points; "waiting time to see provider" increased by 8 points. The other variables measured also showed improvement within the evaluation period. There was a decrease in total LWBE patients of 2.8 % (average). For door to provider, time there was a decrease of 1.03 hours (average). The standing triage committee is responsible for ongoing evaluation of the effectiveness of this process change.
Recommendations: Emergency Departments are facing many challenging issues and antiquated systems will need to adapt to meet these challenges. Utilizing a multidisciplinary approach, having institutional support, and personnel resources to focus on these issues are essential to improving patient care and environment of care for both patients and staff.
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: Innovative Process Redesign Exceeds Outcome Expectationsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162685-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Triage: Innovative Process Redesign Exceeds Outcome Expectations</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">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Carlen-Lindauer, Cathleen, RN, MSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Johns Hopkins Hospital</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Baltimore, MD, 21297-, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(410) 955-4622</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">ccarlen1@jhmi.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Emergency Department overcrowding, long wait times for care, patients leaving the ED without provider evaluation, and low patient satisfaction scores prompted a need for redesign an antiquated triage system. The purpose of this project was to redesign the triage system to improve its efficiency and optimize patient flow. Specifically, the goals were: (1) Decrease &quot;patient arrival to seen by provider&quot; times; (2) decrease number of LWBE (left without being evaluated) patients; (3) increase patient satisfaction score for &quot;waiting time to treatment area&quot; and &quot;waiting time to provider&quot;. <br/><br/>Design: This project is a patient safety and internal process improvement initiative.<br/><br/>Setting: Mid-Atlantic urban academic center, Level I Trauma Center with 65,000 visits per year.<br/><br/>Participants: All Nursing staff, faculty, residents, and mid-level providers in the Adult Emergency Department<br/><br/>Methods: Emergency Department executive leadership initiated a multidisciplinary taskforce to review current system utilization and redesign patient triage and evaluation. Process changes included: (1) Instituting 5-level Emergency Severity Index (ESI) triage system using a two-tiered triage process (2) Immediately assigning the patient to a provider team (3) Utilizing ESI as framework for patient throughput (4) Initiating patient evaluation by a provider at triage (5) Accommodating patient flow by redesigning facility (physical site plan). <br/>Taskforce members piloted the new system to identify issues and obstacles that might impede the implementation. This new process began on January 31, 2006. The Variables measured six months before and after intervention: percentage of patients leaving without complete evaluation, time to provider and patient satisfaction data.<br/><br/>Results: Patient satisfaction data had the most unexpected improvement in this project. Overall patient satisfaction increased by 7.5 points. Focused satisfaction for &quot;waiting time to treatment&quot; increased by 16.5 points; &quot;waiting time to see provider&quot; increased by 8 points. The other variables measured also showed improvement within the evaluation period. There was a decrease in total LWBE patients of 2.8 % (average). For door to provider, time there was a decrease of 1.03 hours (average). The standing triage committee is responsible for ongoing evaluation of the effectiveness of this process change. <br/>Recommendations: Emergency Departments are facing many challenging issues and antiquated systems will need to adapt to meet these challenges. Utilizing a multidisciplinary approach, having institutional support, and personnel resources to focus on these issues are essential to improving patient care and environment of care for both patients and staff.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:25Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:25Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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