2.50
Hdl Handle:
http://hdl.handle.net/10755/162989
Type:
Presentation
Title:
Shared Leadership Triage Process Redesign
Abstract:
Shared Leadership Triage Process Redesign
Conference Sponsor:Emergency Nurses Association
Conference Year:2005
Author:Ledford, Lorie, RN, BSN, CCRN, CEN
P.I. Institution Name:John C. Lincoln Hospital - North Mountain
Contact Address:250 E. Dunlap Ave., Phoenix, AZ, 85308, USA
Contact Telephone:(602) 870-6060
Clinical Topic: Our emergency department (ED) experienced a steadily increasing number of patients seeking care. This increased number of patients resulted in extended wait times for treatment. This project was undertaken to address several triage goals: A) Reduce the risk of under-triage, (B) Improve triage documentation; and C) Streamline patient flow through triage. Implementation: Our two shared leadership committees, Clinical Practice and Education, collaborated to complete several tasks: Design a new charting document and triage protocols, institute a five-level triage system, and develop an improved patient-flow process. Regional and national practices were researched and evaluated. The committee members prepared prototypes that were evaluated by all ED staff. After multiple revisions, consensus was achieved. Five new nurse-driven protocols were developed and implemented, including diphtheria/tetanus, urinalysis, extremity x-ray and antipyretic protocols. The new protocols permitted treatment for these patients to be initiated from triage. The new General Emergency Department Protocol was tied to the Emergency Severity Index (ESI) and permitted the bedside nurse to initiate a range of treatments based on the patient's acuity. The ESI five-level triage acuity system was adopted at the onset of the implementation period. The collaboration of the two shared leadership committees also resulted in the design and implementation of a new charting document. The duties performed by triage personnel were revised to facilitate transition to the new system. The ED clinical staff was educated in all aspects of the new program prior to its implementation. Outcomes: Initially, the tetanus protocol had a 5% compliance rate. Reeducation increased compliance to 80%. The antipyretic protocol has been utilized accurately and has been successful in reducing fever in patients waiting to be seen. The x-ray and urinalysis protocols have successfully reduced wait time for diagnostic exams in selected patients. Audits demonstrated appropriate staff application and utilization of the ESI five-level triage acuity system and the new triage patient flow processes. Staff now has more reliable patient triage data. By adding the acuity scores to our tracking boards, a more complete picture of the department's workload was available to charge nurses. The new chart has streamlined documentation, thereby reducing the time staff spent charting. Outcome data review continued and will continue to be available at the time of presentation. The success of our new system was improved by encouraging and welcoming input from all staff, including administrative and billing personnel, physicians, secretaries, technicians, and registrars. Recommendations: Implementing a reliable acuity rating system is necessary to reduce the risk of patient under-triage. We are utilizing data collected from our acuity rating scores to guide planning of a new fast-track area. We are investigating options for other new protocols. A triage chest x-ray and an infant pain protocol are currently in progress.
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.titleShared Leadership Triage Process Redesignen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162989-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Shared Leadership Triage Process 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">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Ledford, Lorie, RN, BSN, CCRN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">John C. Lincoln Hospital - North Mountain</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">250 E. Dunlap Ave., Phoenix, AZ, 85308, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(602) 870-6060</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">lledfo@jcl.com</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: Our emergency department (ED) experienced a steadily increasing number of patients seeking care. This increased number of patients resulted in extended wait times for treatment. This project was undertaken to address several triage goals: A) Reduce the risk of under-triage, (B) Improve triage documentation; and C) Streamline patient flow through triage. Implementation: Our two shared leadership committees, Clinical Practice and Education, collaborated to complete several tasks: Design a new charting document and triage protocols, institute a five-level triage system, and develop an improved patient-flow process. Regional and national practices were researched and evaluated. The committee members prepared prototypes that were evaluated by all ED staff. After multiple revisions, consensus was achieved. Five new nurse-driven protocols were developed and implemented, including diphtheria/tetanus, urinalysis, extremity x-ray and antipyretic protocols. The new protocols permitted treatment for these patients to be initiated from triage. The new General Emergency Department Protocol was tied to the Emergency Severity Index (ESI) and permitted the bedside nurse to initiate a range of treatments based on the patient's acuity. The ESI five-level triage acuity system was adopted at the onset of the implementation period. The collaboration of the two shared leadership committees also resulted in the design and implementation of a new charting document. The duties performed by triage personnel were revised to facilitate transition to the new system. The ED clinical staff was educated in all aspects of the new program prior to its implementation. Outcomes: Initially, the tetanus protocol had a 5% compliance rate. Reeducation increased compliance to 80%. The antipyretic protocol has been utilized accurately and has been successful in reducing fever in patients waiting to be seen. The x-ray and urinalysis protocols have successfully reduced wait time for diagnostic exams in selected patients. Audits demonstrated appropriate staff application and utilization of the ESI five-level triage acuity system and the new triage patient flow processes. Staff now has more reliable patient triage data. By adding the acuity scores to our tracking boards, a more complete picture of the department's workload was available to charge nurses. The new chart has streamlined documentation, thereby reducing the time staff spent charting. Outcome data review continued and will continue to be available at the time of presentation. The success of our new system was improved by encouraging and welcoming input from all staff, including administrative and billing personnel, physicians, secretaries, technicians, and registrars. Recommendations: Implementing a reliable acuity rating system is necessary to reduce the risk of patient under-triage. We are utilizing data collected from our acuity rating scores to guide planning of a new fast-track area. We are investigating options for other new protocols. A triage chest x-ray and an infant pain protocol are currently in progress.</td></tr></table>en_GB
dc.date.available2011-10-27T10:37:38Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:37:38Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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