title: Pivot Nursing: An Alternative to Traditional ED Triage.
abstract: OBJECTIVE
  A 7.2% increase in patient volume from 130,700 to 140,800 in 2012 prompted St Joseph's Regional Medical Center Emergency Department to review existing triage processes to decrease turnaround time. "Pivot triage" is a new, efficient intake process that entails use of 4 rather than 8 determinants to identify acuity levels. The purpose of this performance improvement project was to create alternatives to traditional triage to decrease ED length of stay and door-to-physician time.
  
  
  METHODS
  After education, the pivot process was implemented using 4 determinants established by a multidisciplinary team. The pivot process was slowly implemented for 6 hours over a 1-week period to work out processing issues. Arrival time, door-to-physician time, and departure time from the emergency department were elements used to calculate the patient's turnaround time. Length of ED stay was collected monthly beginning in the fourth quarter of 2011. Comparisons were made after Pivot implementation in the fourth quarter of 2012.
  
  
  RESULTS
  Despite the increasing volume, the mean door-to-physician time decreased from 71 to 40 minutes, a 43.7% reduction. The overall turnaround time decreased from 220 to 181 minutes, representing approximately a 17.7% reduction. The percentage of patients who left without being seen decreased from 2.5% to 1.0%. The pivot process improved patient flow in the emergency department, reducing time spent by the patient in the department.
  
  
  CONCLUSIONS
  The pivot process is a viable alternative to traditional triage. Nurses are able to accurately pivot patients with a reduced amount of information.
authors.forename: Maria
authors.initials: M
authors.lastname: Christensen
authors.forename: Mark
authors.initials: M
authors.lastname: Rosenberg
authors.forename: Eileen
authors.initials: E
authors.lastname: Mahon
authors.forename: Sharon
authors.initials: S
authors.lastname: Pineda
authors.forename: Eva
authors.initials: E
authors.lastname: Rojas
authors.forename: Victoria
authors.initials: V
authors.lastname: Soque
authors.forename: Mary L
authors.initials: ML
authors.lastname: Johansen
mesh_terms: D003441:Crowding; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods* / Q000458:organization & administration*; D014850:Waiting Lists
keywords: Emergency Department; Flow; Process; Triage