Team Triage

Abstract

Purpose: The Institute of Medicine declared Emergency department (ED) overcrowding as a national crisis. Throughput is a concept used to understand ED overcrowding and is defined as the time measured between a patient’s arrival in the ED to disposition (i.e. discharge or admission). When EDs are overcrowded and throughput is poor, patient safety is compromised, timeliness to appropriate treatment is delayed, and ultimately patient satisfaction plummets. Improving throughput is essential to patient satisfaction, patient outcomes, and the overall hospital process. “Team Triage” (TT), or the introduction of an advanced provider in triage to initiate a treatment plan from triage, is one method to improve throughput. The purpose of this project is to evaluate the influence of “TT” on throughput metrics including length of stay (LOS), left without being seen rates (LWBS), and time to provider (TTP) at the University of Illinois’ Hospital (UIH) ED. Design: Quality improvement project. Setting: A teaching, urban, level II trauma center. Participants/Subjects: All ED staff participated in this project. Methods: “TT” at UIH introduces an APN’s participation to the triage process. The APN initiates a plan of care based on the patient’s medical history, vital signs, and chief complaint at triage. A tech and RN facilitate the “TT” process through executing the treatment plan initiated by the APN. LWBS, LOS, and TTP rates are measured each month after “TT” is introduced to UIH ED. Results/Outcomes: “TT” is a promising method to improve throughput metrics of LWBS, LOS, and TTP. Metrics from July 2016 to June 2017 for LWBS, LOS, and TTP are: 4.5% and 2.6%, 327 minutes to 315 minutes, and 32 minutes and 38 minutes, respectively. UIH will continue to collect, evaluate, and disseminate data to monitor the impact of “TT” on ED metrics. Implications: Introducing an advanced practitioner to the triage process has proven to improve throughput metrics at UIH. Initiating a plan of care from triage can improve patient and staff satisfaction by reducing LOS, improving turn around time for imaging and lab work, and ensuring each patient is seen by an APN within minutes of registering to the ED. Recommendations for researchers is to review the Team Triage impact on Press Ganey scores and the financial impact.