Abstract
Session D presented Thursday, September 27, 2:30-3:30 pm Purpose: Emergency department (ED) triage nurses complained about an ineffective triage process where arriving patients could be missed or treatment could be delayed. The goal for this evidence-based project was to create a triage process, utilizing the Emergency Severity Index (ESI) triage tool and resources to rapidly triage arriving patients, document within the electronic medical record, and direct room patients while communicating with the patient and the ED team effectively. Design: The triage process improvement work, was a staff development project within our unit based shared governance team of ED nurses. Setting: The setting for this triage process improvement project is a level III Trauma Center and is the only hospital located within an 80 mile radius. It serves over 56,000 patients annually within a large, rural, geographical area. Participants/Subjects: All ED staff are encouraged to participate in the unit based shared governance committee. A sub group was created by the committee and included a variety of ED nurses ranging in years of experience. The team also included nurses from day, mid, and night shifts. Methods: A shared governance, sub committee of ED triage nurses worked in collaboration to identify the problems associated with the current triage process, including why triage was chaotic and why times were delayed. The implementation of a new electronic medical record challenged staff to convert a paper triage process to a timely, safe, and effective triage process utilizing the resources included within the new electronic medical record. Analysis of the ESI triage tool/ resources and interpretation of triage requirements according to Washington State law, along with a review of available research and recommendations were analyzed by the committee. The team evaluated times and resources, and goals were developed. A new two tier triage process was proposed. Results/Outcomes: A two tier triage process was implemented. Working in close collaboration with the patient registration team, the primary triage RN also referred to as "triage one" or "pivot nurse" immediately interviews the patient to "sort" or triage utilizing the ESI triage tool. Immediate documentation within the EMR allows the charge nurse, ED staff and ED providers to see the documentation. Based on triage acuity and room availability patients are immediately directed to a room for evaluation by the ED physician. The team implemented the concept of "pull to full" allowing the triage one nurse to always be present for arriving patients. When resources are available, and ED rooms are full, the triage two nurse completes the triage process and works collaboratively to ensure nurse initiated standing orders (NISO's) are initiated and labs are collected. Arrival to triage times have improved from 4 minutes to 3 minutes, arrival to room times have decreased from 23 minutes to 13 minutes , and arrival to provider times have decreased from 55 minutes to 22 minutes. The process continues to be evaluated. Implications: Unit based shared governance, process improvement projects improve staff satisfaction and morale. Education and mentoring is necessary for this to be effective and should be promoted through our professional organization and all ED leaders.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Rapid Triage, Triage, Triage Process
Recommended Citation
Wheeldon, Tami, "Triage - A Time to Change" (2019). General Submissions: Presenations (Oral and Poster). 101.
https://www.sigmarepository.org/gen_sub_presentations/2018/posters/101
Conference Name
Emergency Nursing 2018
Conference Host
Emergency Nurses Association
Conference Location
Pittsburgh, Pennsylvania, USA
Conference Year
2018
Rights Holder
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.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Triage - A Time to Change
Pittsburgh, Pennsylvania, USA
Session D presented Thursday, September 27, 2:30-3:30 pm Purpose: Emergency department (ED) triage nurses complained about an ineffective triage process where arriving patients could be missed or treatment could be delayed. The goal for this evidence-based project was to create a triage process, utilizing the Emergency Severity Index (ESI) triage tool and resources to rapidly triage arriving patients, document within the electronic medical record, and direct room patients while communicating with the patient and the ED team effectively. Design: The triage process improvement work, was a staff development project within our unit based shared governance team of ED nurses. Setting: The setting for this triage process improvement project is a level III Trauma Center and is the only hospital located within an 80 mile radius. It serves over 56,000 patients annually within a large, rural, geographical area. Participants/Subjects: All ED staff are encouraged to participate in the unit based shared governance committee. A sub group was created by the committee and included a variety of ED nurses ranging in years of experience. The team also included nurses from day, mid, and night shifts. Methods: A shared governance, sub committee of ED triage nurses worked in collaboration to identify the problems associated with the current triage process, including why triage was chaotic and why times were delayed. The implementation of a new electronic medical record challenged staff to convert a paper triage process to a timely, safe, and effective triage process utilizing the resources included within the new electronic medical record. Analysis of the ESI triage tool/ resources and interpretation of triage requirements according to Washington State law, along with a review of available research and recommendations were analyzed by the committee. The team evaluated times and resources, and goals were developed. A new two tier triage process was proposed. Results/Outcomes: A two tier triage process was implemented. Working in close collaboration with the patient registration team, the primary triage RN also referred to as "triage one" or "pivot nurse" immediately interviews the patient to "sort" or triage utilizing the ESI triage tool. Immediate documentation within the EMR allows the charge nurse, ED staff and ED providers to see the documentation. Based on triage acuity and room availability patients are immediately directed to a room for evaluation by the ED physician. The team implemented the concept of "pull to full" allowing the triage one nurse to always be present for arriving patients. When resources are available, and ED rooms are full, the triage two nurse completes the triage process and works collaboratively to ensure nurse initiated standing orders (NISO's) are initiated and labs are collected. Arrival to triage times have improved from 4 minutes to 3 minutes, arrival to room times have decreased from 23 minutes to 13 minutes , and arrival to provider times have decreased from 55 minutes to 22 minutes. The process continues to be evaluated. Implications: Unit based shared governance, process improvement projects improve staff satisfaction and morale. Education and mentoring is necessary for this to be effective and should be promoted through our professional organization and all ED leaders.