Triage patient flow redesign in an urban academic emergency department
View File(s)
- Author(s)
- Details
-
Marites Gonzaga-Reardon, MSN, APN, CEN, CCNS-BC, marites_b_gonzaga-reardon@rush.edu; Patricia Altman, MSN, RN, CEN; Runay Valentine, MHA, BSN, RN, CEN, NEA-BC; Frederick Serafin, MBA, BSN, RN, CEN
- Sigma Affiliation
- Non-member
Purpose: The purpose of this process improvement project is to evaluate whether the implementation of “Lean approach” interventions in the triage redesign of an urban academic emergency department improves outcome measures (ED metrics: Left without Being Seen (LWBS), length of stay (LOS), patient satisfaction) and patient experience. This project aims to provide insights on the process improvement interventions implemented to address issues of increased length of stay, increased LWBS and decreased patient satisfaction scores after opening of a new 60 bed ED in an urban academic medical center in January 2012.
Design: This evidence based project is a quality improvement process redesign of the triage patient flow using the “Lean process approach” process improvement methodology. Setting: The study site is a 60 bed urban comprehensive academic ED in Chicago serving an average of 65,000 patients a year. Participants/Subjects: The study population consists of all emergency department (ED) patients’ visits to the ED from January 2012 to December 2013. Methods:
Methods: De-identified data from electronic medical record (EMR) and administrative and clinical data were accessed. Comparisons were made between the 12 months before (January 2012 to November 2012) and 12 months after (from December 2012 to December 2013) implementation of the changes/processes. The triage redesign and rapid improvement process was implemented utilizing the “Lean approach” process improvement methodology through process mapping with ED leadership and staff of ED throughput by identifying patients likely to be discharged from the ED and those likely to be admitted. Data were also obtained from Press Ganey Scores in relation to patient satisfaction.
Results/Outcomes: Following process mapping by staff and ED leadership using “Lean approach” methodology, patient flow in triage pod was restructured concentrating on patients likely to be discharged (those with Emergency Severity Index (ESI) level 4 and 5). Interventions implemented by streaming and directing patients to different care areas in the ED have shown improvement in LWBS and length of stay of patients predicted to be discharged. Average length of stay of patients’ awaiting inpatient beds stayed similarly the same. Patient experience as shown in Press Ganey Patient Satisfaction score improved slightly.
Implications: The use of “Lean approach” process improvement methodology offers improvement opportunities in the emergency department and has shown favorable effects especially with streaming of patients into groups by altering practices in relation to the function of Emergency Severity Index triage scale to improve patient flow and throughput. Further studies are recommended in understanding of”Lean approach” effects in relation to patient safety and quality outcomes and on staff satisfaction.
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Center
Items submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository, unless otherwise noted.
| Type | Poster |
| Acquisition | Proxy-submission |
| Review Type | Abstract Review Only: Reviewed by Event Host |
| Evidence Level | N/A |
| Research Approach | N/A |
| Keywords | Triage Redesign; Triage Patient Flow |
| Name | 2014 ENA Annual Conference |
| Host | Emergency Nurses Association |
| Location | Indianapolis, Indiana, U.S.A. |
| Date | 2014 |
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Related items
Showing items related by title, author, creator and subjects.
-
What is the effect on knowledge, staff satisfaction and competency of care after educating providers on emergency department triage in an urban academic medical center?
(2016-03-17)Session presented on Saturday, July 25, 2015: Background. Hospitals in recent years have shown an increase in overcrowding in their emergency departments due to hospital closures, lack of primary care and an aging population. ... -
A nurse practitioner driven, split-flow emergency department intake system
(9/21/2017)As hospital emergency departments (EDs) in the United States face an increased patient volume, challenges emerge to provide effective patient care. This quality improvement project addresses the gaps in ED patient care ... -
Implementation of a vertical care area and enhancement of the triage process for patient throughput in a freestanding emergency department
(2017-12-05)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 ... -
Triage accuracy of pediatric patients using the Korean Triage and Acuity Scale in emergency departments
The purpose of this study was to identify emergency department triage accuracy using the Korean Triage and Acuity Scale (KTAS) and evaluate the causes of mistriage and clinical outcomes. -
Fast forward to a future state: Reengineering emergency department flow
Session G presented Friday, September 28, 1:00-2:00 pm Purpose: Emergency Departments (EDs) face many challenges. Managing the influx of new patients and overall patient flow in busy EDs is a challenge. Dealing with ...
