Title : They say it cannot be done: A nursing led initiative to change Psychiatric ED triage procedures to improve patient care
Abstract:
Background
Psychiatric emergency room visits are often associated with long wait times, leading to agitation and dissatisfaction among patients, delay in care, some patients leaving without receiving care, staff frustration and increased cost. Research indicates that triage guidelines correlate with wait times and patient satisfaction. In the behavioral Health Emergency Room long wait times leads to a backlog of patients siting in an already cramped and small waiting room, extended length of stay, sometimes leads to unintentional admissions due to patients becoming upset and acting out and some patients leaving before receiving treatment.
Method
A nurse led initiative in collaboration with Performance Excellence Center recognized the work duplication, unnecessary motion for patients, nurses, and providers, overprocessing low complexity patients leading to unnecessary wait times for all patients. Triage process was changed to create a sorting nurse to classify and expediate patients to low complexity versus high complexity patients who might require admission. Focused assessments were instituted as it was determined full assessment are not needed to determine disposition. The provider was placed in triage and the nurse jointly completed the assessment.
Results/Conclusions
Triage protocol nurse initiative was positive for decreasing length of stay metrics for low complexity patients and for patients who presented, requiring thorough assessment and admission to Observation unit. Door to discharge time decreased for low acuity patients by 25.3% from 245 minutes to 193 minutes. Door to admission to Observation unit decreased by 21.5% from 265 minutes to 208 minutes. In addition, the percentage of patients leaving without being seen decreased by 42%. In addition, pre and post survey on triage showed significant improvement and satisfaction with the new triage protocol.
Audience Take Away Notes:
- Identify how to make systems change by addressing concerns or challenges involved in implementing nursing initiative to change triage procedure.
- Explain how mainstreaming triage enables nurses to recognize early warning signs that require immediate attention and provide appropriate interventions
- Summarize the benefits of mainstreaming triage protocol: reduce wait times, decrease patients leaving without being seen, improve staff satisfaction
- Discuss ways this process can be incorporate in a medical focused emergency department
- Discuss strategies and solutions to address concerns with changing procedures, such as engaging staff in the change process, staff training and interdisciplinary collaboration
