2.50
Hdl Handle:
http://hdl.handle.net/10755/162901
Type:
Presentation
Title:
Development and Implementation of a Two-Step Triage Process
Abstract:
Development and Implementation of a Two-Step Triage Process
Conference Sponsor:Emergency Nurses Association
Conference Year:2006
Author:Fry, Kathy, RN, BSN
P.I. Institution Name:Northwest Hospital Center
Title:Clinical Specialist, Emergency Department
Contact Address:5401 Old Court Rd., Randallstown, MD, 21133, USA
Contact Telephone:(410) 521-2200
Clinical Topic: Lack of appropriate personnel and growing patient volumes of 50,000-plus emergency department (ED) visits annually at this community-based hospital created constant triage backlogs, despite use of the ESI (Emergency Severity Index) five-tiered triage system. Compounding matters was our new physical layout, part of a hospital-wide reconstruction project, which prevented the triage nurses' view of incoming patients, and hence the ability to quickly assess patient acuity and need for immediate response. To address these problems, an ED-driven committee developed a plan to improve the triage process and ensure quick and accurate provision of patient care. Implementation: Made up of ED nurses and technicians, the Triage Committee, in August 2004, reviewed and analyzed ED patient flow and processes, conducted a literature search, made site visits to area facilities with similar demographics, and enlisted all ED staff input on how to improve ED patient flow and processes. The resulting proposal, approved by the Executive Team, and completed in 2004, at a cost of nearly $250,000, recommended dividing ED triage into two areas and increasing FTEs and equipment to support the change. Thirteen, two-hour educational sessions oriented more than 80 essential personnel on how the new layout and concomitant process changes would impact their jobs. In July 2005, the Quick Look Nursing Station (QLNS) (located in the waiting area, with full view of the front door), and the Full Triage Nursing Station (FTNS) opened their doors for business. Patients are now seen immediately by the QLTS nurse, who assigns an ESI code, then by the FTNS nurse, according to ESI number. In addition, nurses rather than security or registration personnel, are first to acknowledge incoming patients, and acuity levels are now assigned within 2-3 minutes from when the patient walks into the ED. In addition, triage technicians are assigned to and operate under the direct supervision of the full triage nurse rather than the charge nurse. Outcomes: Although we continue to refine the triage process and patient flow, preliminary results indicate consistent reduction in time from patient arrival to ED bed--from 96 minutes in January 2005 to 76 minutes in January 2006, and from 95 minutes in February 2005 to 81 minutes in February 2006, and a more than 10-minute reduction in the average patient wait to treatment. ESI coding for accuracy - for both individual nurses and as a team, has improved, based on monthly ESI audits. Importantly, the two-step process has allowed us to quickly get the sickest patients back to a limited number of open beds. Verbal reports from patients and family indicate satisfaction with our new system, and Press Ganey Scores should confirm this when comparisons are made in July, one year after project implementation. Another important, albeit, ongoing consequence of the project is the sense of teamwork, collaboration and staff empowerment it continues to engender. Recommendations: Keeping patients safe and improving delivery of care is not a static process, constant reevaluation of current practices and procedures is essential. Organizations that stay in tune with caregivers at the front lines stay ahead of institutions that do not. Involving staff at all levels of the decision making process promotes feelings of empowerment, leads individuals to take vested interest in common goals, and may even motivate staff more than any tangible reward.
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.titleDevelopment and Implementation of a Two-Step Triage Processen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162901-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Development and Implementation of a Two-Step Triage Process</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">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Fry, Kathy, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Northwest Hospital Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Specialist, Emergency Department</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">5401 Old Court Rd., Randallstown, MD, 21133, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(410) 521-2200</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mfry@lifebridgehealth.org</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: Lack of appropriate personnel and growing patient volumes of 50,000-plus emergency department (ED) visits annually at this community-based hospital created constant triage backlogs, despite use of the ESI (Emergency Severity Index) five-tiered triage system. Compounding matters was our new physical layout, part of a hospital-wide reconstruction project, which prevented the triage nurses' view of incoming patients, and hence the ability to quickly assess patient acuity and need for immediate response. To address these problems, an ED-driven committee developed a plan to improve the triage process and ensure quick and accurate provision of patient care. Implementation: Made up of ED nurses and technicians, the Triage Committee, in August 2004, reviewed and analyzed ED patient flow and processes, conducted a literature search, made site visits to area facilities with similar demographics, and enlisted all ED staff input on how to improve ED patient flow and processes. The resulting proposal, approved by the Executive Team, and completed in 2004, at a cost of nearly $250,000, recommended dividing ED triage into two areas and increasing FTEs and equipment to support the change. Thirteen, two-hour educational sessions oriented more than 80 essential personnel on how the new layout and concomitant process changes would impact their jobs. In July 2005, the Quick Look Nursing Station (QLNS) (located in the waiting area, with full view of the front door), and the Full Triage Nursing Station (FTNS) opened their doors for business. Patients are now seen immediately by the QLTS nurse, who assigns an ESI code, then by the FTNS nurse, according to ESI number. In addition, nurses rather than security or registration personnel, are first to acknowledge incoming patients, and acuity levels are now assigned within 2-3 minutes from when the patient walks into the ED. In addition, triage technicians are assigned to and operate under the direct supervision of the full triage nurse rather than the charge nurse. Outcomes: Although we continue to refine the triage process and patient flow, preliminary results indicate consistent reduction in time from patient arrival to ED bed--from 96 minutes in January 2005 to 76 minutes in January 2006, and from 95 minutes in February 2005 to 81 minutes in February 2006, and a more than 10-minute reduction in the average patient wait to treatment. ESI coding for accuracy - for both individual nurses and as a team, has improved, based on monthly ESI audits. Importantly, the two-step process has allowed us to quickly get the sickest patients back to a limited number of open beds. Verbal reports from patients and family indicate satisfaction with our new system, and Press Ganey Scores should confirm this when comparisons are made in July, one year after project implementation. Another important, albeit, ongoing consequence of the project is the sense of teamwork, collaboration and staff empowerment it continues to engender. Recommendations: Keeping patients safe and improving delivery of care is not a static process, constant reevaluation of current practices and procedures is essential. Organizations that stay in tune with caregivers at the front lines stay ahead of institutions that do not. Involving staff at all levels of the decision making process promotes feelings of empowerment, leads individuals to take vested interest in common goals, and may even motivate staff more than any tangible reward.</td></tr></table>en_GB
dc.date.available2011-10-27T10:36:05Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:36:05Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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