2.50
Hdl Handle:
http://hdl.handle.net/10755/162698
Type:
Presentation
Title:
Triage Redesign
Abstract:
Triage Redesign
Conference Sponsor:Emergency Nurses Association
Conference Year:2008
Author:Goss, Katy, RN, MSN
P.I. Institution Name:Holy Cross Hospital
Title:Director Emergency Department
Contact Address:, Silver Spring, MD, 20910-, USA
Contact Telephone:(301) 754-7502
Purpose: The redesign was initiated to improve internal Emergency Department (ED) throughput processes independent of hospital inpatient census and/or ED volume.

Design: This was an ED operations project.

Setting: The ED is in a 450 bed urban hospital with an annual ED volume of 73,000.

Participants/Subjects: Not a human subject project.

Methods: Both the physical space and flow were redesigned for this project. The physical triage space changed from three triage areas to a "sort", assessment and discharge area. The process prior to redesign, had the patient presenting to non-clinical personnel, proceeding to the triage nurse, and then to a six bed area for implementation of protocols. This process frequently allowed patients to have prolonged waiting room times with unknown medical conditions. In addition, the six bed area frequently was expanded to accommodate as many as twenty patients in order to implement standing protocols.

The process was changed so that the patient's first encounter is with a Registered Nurse (RN). The "sort" nurse obtains the complaint and pertinent history, determines appropriate location within the Emergency Department (adult, pediatric or Express Care) for the patient and obtains only exclusionary vital sign(s) for Express Care patients. When the appropriate bed is available, the patient is directly triaged to that area. When there is not an available bed the patient is placed in the assessment area for vital signs and implementation of appropriate protocols. The assessment nurse further determines if it is safe for the patient to be placed in the waiting room. If after further evaluation, the assessment nurse determines that the patient would be at risk in the waiting room, the charge nurse is notified and a bed is made. The assessment area is not a holding area for patients.

The six bed area was converted to a "discharge" area. The ED physicians identify patients that are "probable for discharge". This process allows the acute bed to become available for an "incoming" patient in a timely manner.

Results: For purposes of this paper the six months prior to the triage redesign and six months after were compared. A random sample of patients showed since implementation the door to triage time has decreased from an average of one (1) to 0.5 minutes. The doors to provider times have decreased from an average of 44 to 22 minutes. The length of stay (LOS) for all patients has decreased from 194 to 159 minutes with the LOS for discharged patients decreasing from 199 to 171 minutes. The left without being seen rate has decreased from a high of 1.7% to a low of 0.7% with an average of 1.2%.

Recommendations: The preliminary results show an improvement in door to triage and door to provider resulting in decreased risk to the patient in the event of prolonged wait time for a bed.
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 Redesignen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162698-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Triage Redesign</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">Goss, Katy, RN, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Holy Cross Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Director Emergency Department</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Silver Spring, MD, 20910-, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(301) 754-7502</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">gossk@holycrosshealth.org</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The redesign was initiated to improve internal Emergency Department (ED) throughput processes independent of hospital inpatient census and/or ED volume.<br/><br/>Design: This was an ED operations project.<br/><br/>Setting: The ED is in a 450 bed urban hospital with an annual ED volume of 73,000.<br/><br/>Participants/Subjects: Not a human subject project.<br/><br/>Methods: Both the physical space and flow were redesigned for this project. The physical triage space changed from three triage areas to a &quot;sort&quot;, assessment and discharge area. The process prior to redesign, had the patient presenting to non-clinical personnel, proceeding to the triage nurse, and then to a six bed area for implementation of protocols. This process frequently allowed patients to have prolonged waiting room times with unknown medical conditions. In addition, the six bed area frequently was expanded to accommodate as many as twenty patients in order to implement standing protocols. <br/><br/>The process was changed so that the patient's first encounter is with a Registered Nurse (RN). The &quot;sort&quot; nurse obtains the complaint and pertinent history, determines appropriate location within the Emergency Department (adult, pediatric or Express Care) for the patient and obtains only exclusionary vital sign(s) for Express Care patients. When the appropriate bed is available, the patient is directly triaged to that area. When there is not an available bed the patient is placed in the assessment area for vital signs and implementation of appropriate protocols. The assessment nurse further determines if it is safe for the patient to be placed in the waiting room. If after further evaluation, the assessment nurse determines that the patient would be at risk in the waiting room, the charge nurse is notified and a bed is made. The assessment area is not a holding area for patients.<br/><br/>The six bed area was converted to a &quot;discharge&quot; area. The ED physicians identify patients that are &quot;probable for discharge&quot;. This process allows the acute bed to become available for an &quot;incoming&quot; patient in a timely manner.<br/><br/>Results: For purposes of this paper the six months prior to the triage redesign and six months after were compared. A random sample of patients showed since implementation the door to triage time has decreased from an average of one (1) to 0.5 minutes. The doors to provider times have decreased from an average of 44 to 22 minutes. The length of stay (LOS) for all patients has decreased from 194 to 159 minutes with the LOS for discharged patients decreasing from 199 to 171 minutes. The left without being seen rate has decreased from a high of 1.7% to a low of 0.7% with an average of 1.2%.<br/><br/>Recommendations: The preliminary results show an improvement in door to triage and door to provider resulting in decreased risk to the patient in the event of prolonged wait time for a bed.</td></tr></table>en_GB
dc.date.available2011-10-27T10:32:37Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:37Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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