Poster Abstract
Shared Leadership Triage Process Redesign

https://doi.org/10.1016/j.jen.2005.12.024Get rights and content

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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

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

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.

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