2.50
Hdl Handle:
http://hdl.handle.net/10755/324153
Category:
Abstract
Type:
Presentation
Title:
Provider at Triage
Author(s):
Barnes, Malloree
Author Details:
Malloree Barnes, BSN, RN, email: malloree.barnes@providence.org
Abstract:
Evidence-based Practice Abstract Purpose: Non-emergent patients who present to the Emergency Department (ED) often wait an excessive amount of time to see a provider. A key driver of ED patient satisfaction is the wait time to see a provider, as well as the overall length of stay in the department. During hours of peak volume, a process was needed to improve throughput, thereby reducing door to provider time and inversely increasing patient satisfaction. Design: A multidisciplinary team reviewed current literature and conducted site visits to determine a plan to improve throughput of lower acuity patients. The team eliminated the old triage method and replaced it with a midlevel provider and nurse team at the “front end” to initiate the evaluation and treatment of patients when bed availability was limited. Setting: An urban level III Emergency/Trauma Center with an annual volume of approximately 65,000 patients. Participants/Subjects: The multidisciplinary team consisted of nurses, physicians, midlevel providers, registration, diagnostic imaging, laboratory, and operational excellence staff. A member of the hospital’s Patient Advisory Council also participated on the team. ESI Level 3, 4, 5 patients were identified as key stakeholders in this process change, as they reflect approximately 75% of patients who seek care in the ED. Often these patients languish in the waiting area for two-to-four hours before treatment by a provider is initiated. Methods: The team utilized a rapid cycle improvement process to design and implement the new ‘Provider at Triage’ model. Over a two month period, the team mapped out the new process which included key elements of: staffing, hours of operation, equipment, supplies, medications, and changes to process flow. Team members then piloted the new process on Saturday, Sunday, and Monday from 11AM to 11 PM for eight weeks. The team met each Wednesday to debrief, review the previous week’s metrics, identify learning’s, and determine process revisions which would be implemented the following weekend. Metrics reviewed each week included: length of stay (LOS) by ESI level, patient satisfaction scores, and patients having left without being seen. Results/Outcomes: Since the Provider at Triage model has been implemented, there has been a significant reduction in the process standard deviation (p<0.05). LOS for admitted ESI level 3 patients decreased from 6 hours and 10 minutes to 4 hours and 33 minutes, a 26% reduction. LOS for discharged patients also showed a significant reduction, ESI level 3 patients reduced by 22%, ESI level 4 patients by 31%, and ESI level 5 patients by 57%. Implications: This process change has demonstrated the positive benefits of the Provider at Triage model. For successful implementation of this model two key elements must be in place. First, engagement of a multidisciplinary team invested and involved in all aspects of the design and implementation plan is critical. Secondly, having the team provide oversight while the new model is being implemented is crucial in order to ensure consistent application of the model and provides time to make certain the processes are hardwired.
Repository Posting Date:
4-Aug-2014
Date of Publication:
4-Aug-2014
Conference Date:
2014
Conference Name:
2014 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Phoenix, Arizona USA
Description:
2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleProvider at Triageen_GB
dc.contributor.authorBarnes, Malloreeen_GB
dc.author.detailsMalloree Barnes, BSN, RN, email: malloree.barnes@providence.orgen_GB
dc.identifier.urihttp://hdl.handle.net/10755/324153-
dc.description.abstractEvidence-based Practice Abstract Purpose: Non-emergent patients who present to the Emergency Department (ED) often wait an excessive amount of time to see a provider. A key driver of ED patient satisfaction is the wait time to see a provider, as well as the overall length of stay in the department. During hours of peak volume, a process was needed to improve throughput, thereby reducing door to provider time and inversely increasing patient satisfaction. Design: A multidisciplinary team reviewed current literature and conducted site visits to determine a plan to improve throughput of lower acuity patients. The team eliminated the old triage method and replaced it with a midlevel provider and nurse team at the “front end” to initiate the evaluation and treatment of patients when bed availability was limited. Setting: An urban level III Emergency/Trauma Center with an annual volume of approximately 65,000 patients. Participants/Subjects: The multidisciplinary team consisted of nurses, physicians, midlevel providers, registration, diagnostic imaging, laboratory, and operational excellence staff. A member of the hospital’s Patient Advisory Council also participated on the team. ESI Level 3, 4, 5 patients were identified as key stakeholders in this process change, as they reflect approximately 75% of patients who seek care in the ED. Often these patients languish in the waiting area for two-to-four hours before treatment by a provider is initiated. Methods: The team utilized a rapid cycle improvement process to design and implement the new ‘Provider at Triage’ model. Over a two month period, the team mapped out the new process which included key elements of: staffing, hours of operation, equipment, supplies, medications, and changes to process flow. Team members then piloted the new process on Saturday, Sunday, and Monday from 11AM to 11 PM for eight weeks. The team met each Wednesday to debrief, review the previous week’s metrics, identify learning’s, and determine process revisions which would be implemented the following weekend. Metrics reviewed each week included: length of stay (LOS) by ESI level, patient satisfaction scores, and patients having left without being seen. Results/Outcomes: Since the Provider at Triage model has been implemented, there has been a significant reduction in the process standard deviation (p<0.05). LOS for admitted ESI level 3 patients decreased from 6 hours and 10 minutes to 4 hours and 33 minutes, a 26% reduction. LOS for discharged patients also showed a significant reduction, ESI level 3 patients reduced by 22%, ESI level 4 patients by 31%, and ESI level 5 patients by 57%. Implications: This process change has demonstrated the positive benefits of the Provider at Triage model. For successful implementation of this model two key elements must be in place. First, engagement of a multidisciplinary team invested and involved in all aspects of the design and implementation plan is critical. Secondly, having the team provide oversight while the new model is being implemented is crucial in order to ensure consistent application of the model and provides time to make certain the processes are hardwired.en_GB
dc.date.available2014-08-04T13:28:28Z-
dc.date.issued2014-08-04-
dc.date.accessioned2014-08-04T13:28:28Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationPhoenix, Arizona USAen_GB
dc.description2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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