Issue 3 : Improving triage process

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1. Define in 10-20 words.

  • Improving the triage process to accommodate more people, and influxes of people, in a shorter amount of time while ensuring patient safety, process effectiveness, and process efficiency.

2. Research: What information were you able to find on the web or from readings?

  • The triage process should consist of escorting or transporting the patient to an open exam/treatment room where staff may assess the patient's condition and begin treatment without delay.
  • Turning Around: Triage is becoming more important as the number of patients in the EDs is increasing and the average length of stay of an ED patient is rising as well. There are needs to assess the sick quicker and more systematically. This paper discusses the system changes made to improve the triage process by changing the registration process and adding a fast tracking system.

(Morgan, 2007).

  • Bedside registration has been known to help to decrease the LOS by 46 mins. (Etiel, 2008)
  • One study showed that optimum time to decide a triage level was 2 mins. But then subsequently found that the triage time only falls within this time frame 22% of the time. The average time was 4 mins or 6 mins depending on if vital signs were needed or not. (Travers, 1999).
  • From the Experts:
    • The problem of triage is doubled when combined with bottlenecks in the ED. Simultaneous arrival of patients causes for a majority of these bottlenecks.

3. How can the problem be measured?

  • Number of patients seen during fixed amount of time
  • Amount of time spent by patient from door-to-triage
  • Arrivals/hour
  • Arrivals/time of day
  • Arrivals/day of the week
  • Time from Registration to Triage
  • Time from Triage to Bed
  • Time from Door to Provider
  • How many levels of triage are there
  • Where do they go from triage
  • How many ways to get to triage
  • How many items do we need to place a patient in a triage category?
  • Time to get each item from the patient
  • Time to decide on a treatment for the patient
  • Does the Item amount vary for different conditions?
  • How many different decision paths will the triage nurse go through?

COMMENTS: Ackerman Triage is a huge problem. Even with "standardized" triage processes there is poor interrater reliability. It is very easy to significantly over or under estimate the severity and acuity of disease process at first glance. As I see it "streamlining" is neither a problem or a solution. The problem is that triage is a time, space, and resource consuming task that needs to be completed in a timely fashion, in limited space and with scarce resources. A problem statement might be "Triage cannot be completed in a timely fashion for all patients when multiple patients arrive at one time"

There are at least 5 major ED triage systems used in the US and Europe each modified significantly by local practice. You should have an overwelming number of references for this. Through put is an excellent metric, time to decision may be useful.

References: 1. Etiel D R, et al. Improving Service Quality by Understanding ED Flow. Journal of Emergency Medicine. 2008.

2. Morgan R. Turning around the turn-arounds. Journal of Emergency Nursing. Vol. 33. Is. 6. 2007.

3. Travers D. Triage: How long does it take? How long should it take? Journal of Emergency Nursing. Vol. 25. Is. 3. 1999.