Triage Space Redesign to Facilitate Application of Relationship Based Care

Abstract

Purpose: The previous Emergency Department triage space was inadequate to meet the hospitalÆs mission and vision to provide a patient centered focus of care. The Goal established for this project was to create an environment conducive to care which would place the patient and family at the center of triage activity, and facilitate assessment of all patients within the ED scope of service including those with special needs. <br/><br/>Design: This is an Evidence-Based project designed to apply principles of Relationship Based Care¬, the hospitalÆs selected professional practice model. <br/><br/>Setting: A community based, level II trauma center in the Midwest with 32,000 annual visits. <br/><br/>Participants: A convenience sample of Emergency Department patients who had experienced both the old and the new triage space were requested to voluntarily complete a survey which compared perceptions of the old and new triage designs. Additionally, ED patients are mailed Press-Ganey surveys to assess dimensions of patient satisfaction using the sampling processes established by that company, with results benchmarked against national comparison groups. <br/><br/>Methods: Project Procedures: The project was developed by a member of the Emergency Department Unit Operations Council, with input provided by direct-care nurse members, as well as architectural, engineering, and design experts. Evaluation Methods: Methods to evaluate the effectiveness of this project included development and utilization of a tool to assess goal achievement, and measurement of patient satisfaction scores pre and post project implementation. The instrument created by the Project Leader was a ten question Likert scale survey which compared patient perceptions of the previous and redesigned space, which was based on care delivery and the patient and family dimensions extracted from concepts of Relationship Based Care. No validity or reliability for this instrument has been established. <br/><br/>Results and Outcomes: The Likert scale survey results showed the new triage room was more spacious, more accommodating, provided more privacy, and most importantly provided an environment of caring. 100% of patients were both completely satisfied and found the new room accommodating, compared to 15% with the old room. 100% of patients found the room to provide more privacy and was more spacious, compared to 45% and 15% respectively. 85% of patients found the new room to provide an environment of caring compared to 28% with the old room. Press Ganey scores showed drastic improvement post implementation from the 65th percentile in 3rd quarter 2008 to the 93rd percentile in 1st quarter 2009 when compared to the large database. It must be recognized that change in the triage environment is not the only variable that may have influenced patient satisfaction during this period of time. <br/><br/>Implications: The physical environment in which care is provided can facilitate the implementation and use of models of care. Leadership support is instrumental to obtain the funding necessary to drive structural changes. <br/></td></tr></table>