Implementation of a Vertical Care Area and Enhancement of the Triage Process for Patient Throughput in a Freestanding Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/623679
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Implementation of a Vertical Care Area and Enhancement of the Triage Process for Patient Throughput in a Freestanding Emergency Department
Author(s):
McLary, Katharine
Lead Author STTI Affiliation:
Non-member
Author Details:
Katharine McLary, BSN, RN
Abstract:

Poster presentation

Session G presented Saturday, September 16, 2017

Purpose: The objective of this performance improvement project was to improve the overall triage process and create a vertical care treatment area in the freestanding emergency department to decrease left without being seen rates and improve the throughput experience for patients.

Design: This evidence-based project was nurse driven to implement best practice for patients in a free standing emergency department.

Setting: The setting of this performance improvement project is a 14 bed free standing emergency department in a community outside of Charlotte, NC.

Participants/Subjects:
This was an evidence-based process improvement project that did not have a set of participants for study. It was an inclusive project that required all ED staff to participate.

Methods: Design and Implement Project: * Retrieve and compile data for pre-pilot length of stay for discharged patients, left without being seen rates and Press-Ganey overall patient satisfaction scores; * Streamline triage; every RN must take a triage class for uniformity of the ESI level assignment; * Add a Patient Care Partner to assist the triage RN with vital signs and rooming patients; * Use the “Pull till Full” concept of in room triage of patients when there are open beds in the department; * Initiate “Code Triage” if there are 5 or more patients in the waiting room to be triaged; * Creation of 2 Vertical Care beds and 2 lower acuity rooms to improve throughput of ESI level 4s and 5s; * Integrate the use of a rolling triage cart to improve overall triage times, thus decreasing overall length of stay.

Results/Outcomes: A pilot study was initiated over four weeks from 5/6/2016-6/2/2016. There was a decrease in length of stay from 148 minutes to 132 minutes. The left without being seen rate also decreased from 2.44% to 1.24%. Overall patient satisfaction increased from 38% to 93%.

Implications: Key Accomplishments include decreased overall length of stay for discharged patients with a rise in the average daily patient census. Our department exceeded the top box score on Press-Ganey overall patient satisfaction with implementation of a vertical care area and streamlined triage process. Barriers identified include staffing challenges, initial staff buy in and inconsistent ESI triage level assignment prior to all RNs taking a standardized triage class. Another factor of consideration is the continual rise in patient volume. It was identified that Mondays had the largest volume of patients and the highest left without being seen rates. This pilot study was successful and has been adopted as a new practice change. The implementation of a vertical care treatment area is an ongoing project. The next steps for integration and growth include the expansion of the vertical care area, additional staff education on appropriate patients to be treated in the vertical care area and the introduction of a split flow model for ESI level 3 patients that could appropriately be cared for in the vertical care area. In addition the planning and construction of an new triage area is being investigated. This process change has also been adopted at our sister Freestanding Emergency Department, Harrisburg.

Keywords:
Throughput; Triage; Emergency Department
Repository Posting Date:
5-Dec-2017
Date of Publication:
5-Dec-2017
Conference Date:
2017
Conference Name:
Emergency Nursing 2017
Conference Host:
Emergency Nurses Association
Conference Location:
St. Louis, Missouri, USA
Description:
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleImplementation of a Vertical Care Area and Enhancement of the Triage Process for Patient Throughput in a Freestanding Emergency Departmenten_US
dc.contributor.authorMcLary, Katharineen
dc.contributor.departmentNon-memberen
dc.author.detailsKatharine McLary, BSN, RNen
dc.identifier.urihttp://hdl.handle.net/10755/623679-
dc.description.abstract<p>Poster presentation</p> <p>Session G presented Saturday, September 16, 2017</p> <p>Purpose: The objective of this performance improvement project was to improve the overall triage process and create a vertical care treatment area in the freestanding emergency department to decrease left without being seen rates and improve the throughput experience for patients.</p> <p>Design: This evidence-based project was nurse driven to implement best practice for patients in a free standing emergency department.</p> <p>Setting: The setting of this performance improvement project is a 14 bed free standing emergency department in a community outside of Charlotte, NC.</p> <p>Participants/Subjects:<br />This was an evidence-based process improvement project that did not have a set of participants for study. It was an inclusive project that required all ED staff to participate.</p> <p>Methods: Design and Implement Project: * Retrieve and compile data for pre-pilot length of stay for discharged patients, left without being seen rates and Press-Ganey overall patient satisfaction scores; * Streamline triage; every RN must take a triage class for uniformity of the ESI level assignment; * Add a Patient Care Partner to assist the triage RN with vital signs and rooming patients; * Use the &ldquo;Pull till Full&rdquo; concept of in room triage of patients when there are open beds in the department; * Initiate &ldquo;Code Triage&rdquo; if there are 5 or more patients in the waiting room to be triaged; * Creation of 2 Vertical Care beds and 2 lower acuity rooms to improve throughput of ESI level 4s and 5s; * Integrate the use of a rolling triage cart to improve overall triage times, thus decreasing overall length of stay.</p> <p>Results/Outcomes: A pilot study was initiated over four weeks from 5/6/2016-6/2/2016. There was a decrease in length of stay from 148 minutes to 132 minutes. The left without being seen rate also decreased from 2.44% to 1.24%. Overall patient satisfaction increased from 38% to 93%.</p> <p>Implications: Key Accomplishments include decreased overall length of stay for discharged patients with a rise in the average daily patient census. Our department exceeded the top box score on Press-Ganey overall patient satisfaction with implementation of a vertical care area and streamlined triage process. Barriers identified include staffing challenges, initial staff buy in and inconsistent ESI triage level assignment prior to all RNs taking a standardized triage class. Another factor of consideration is the continual rise in patient volume. It was identified that Mondays had the largest volume of patients and the highest left without being seen rates. This pilot study was successful and has been adopted as a new practice change. The implementation of a vertical care treatment area is an ongoing project. The next steps for integration and growth include the expansion of the vertical care area, additional staff education on appropriate patients to be treated in the vertical care area and the introduction of a split flow model for ESI level 3 patients that could appropriately be cared for in the vertical care area. In addition the planning and construction of an new triage area is being investigated. This process change has also been adopted at our sister Freestanding Emergency Department, Harrisburg.</p>en
dc.subjectThroughputen
dc.subjectTriageen
dc.subjectEmergency Departmenten
dc.date.available2017-12-05T21:28:26Z-
dc.date.issued2017-12-05-
dc.date.accessioned2017-12-05T21:28:26Z-
dc.conference.date2017en
dc.conference.nameEmergency Nursing 2017en
dc.conference.hostEmergency Nurses Associationen
dc.conference.locationSt. Louis, Missouri, USAen
dc.descriptionENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missourien
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.