Outcomes of implementing rapid triage in the pediatric emergency department.
BACKGROUND
Efficiency and effectiveness are often used as quality indicators in emergency departments. With an aim to improve patient throughput and departmental efficiency while decreasing left-without-being-seen (LWBS) rates, this two-group, pre-intervention, post-intervention study in a pediatric emergency department evaluated the outcomes of implementing rapid triage on arrival-to-triage time, fast track utilization, and LWBS.


METHODS
We implemented rapid triage assessment integrating the Emergency Severity Index and fast track guidelines in our pediatric emergency department. Arrival-to-triage times were tracked for 1 month before and after the intervention (N = 13,910 patient visits) by recording the time the patient arrived in the department and time triage assessment was complete. Fast track utilization and LWBS rates were measured for all patients sequentially included in pre-intervention (n = 60,373) and post-intervention (n = 67,939) groups for 10 months.


RESULTS
After the intervention, patients experienced a significant decrease in arrival-to-triage times compared with the pre-intervention group (P < .001), with most patients (88.3%) being triaged in less than 10 minutes after the intervention. Following implementation of fast track guidelines, patients were 14% more likely to be triaged to fast track compared with pre-intervention patients (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.11-1.67). Additionally, patients with the lowest acuity were nearly 50% more likely to be triaged to fast track compared with pre-intervention patients (OR = 1.48, 95% CI = 1.35-1.63). Although LWBS rates were insignificant, overall acuity level of this group was lower in the post-intervention group.


CONCLUSIONS
Although LWBS rates did not decrease with the intervention, implementation of a rapid triage system and fast track guidelines reduced arrival-to-triage times and decreased acuity in the LWBS population. Implementing rapid triage and fast track guidelines can affect nurse-sensitive patient outcomes related to safety and care delivery in a pediatric emergency department.
Kansas City, MO; Washington, DC. Electronic address: sdoyle@cmh.edu.
Stacy L
SL
Doyle
Kansas City, MO; Washington, DC.
Jennifer
J
Kingsnorth
Kansas City, MO; Washington, DC.
Cathie E
CE
Guzzetta
Kansas City, MO; Washington, DC.
Sara A
SA
Jahnke
Kansas City, MO; Washington, DC.
Johanna C
JC
McKenna
Kansas City, MO; Washington, DC.
Kathleen
K
Brown
D017598:Efficiency, Organizational; D016529:Emergency Nursing / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D013997:Time Factors; D017749:Total Quality Management; D014218:Triage; D014481:United States; D014850:Waiting Lists