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Outcomes of implementing rapid triage in the pediatric emergency department
Stacy L Doyle1, Jennifer Kingsnorth1, Cathie E Guzzetta1
1Kansas City, MO; Washington, DC.
Insights
Implementing rapid triage in pediatric emergency departments significantly reduced patient wait times. While left-without-being-seen rates did not change, the intervention improved patient flow and safety outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Patient Flow Optimization
Background:
- Emergency departments (EDs) use efficiency and effectiveness as key quality indicators.
- Improving patient throughput and reducing left-without-being-seen (LWBS) rates are critical goals.
- This study evaluated a rapid triage intervention in a pediatric ED.
Purpose of the Study:
- To assess the impact of rapid triage on arrival-to-triage time.
- To evaluate changes in fast track utilization post-intervention.
- To determine the effect of rapid triage on LWBS rates in a pediatric ED.
Main Methods:
- A pre-intervention, post-intervention study design was employed.
- Rapid triage assessment integrated Emergency Severity Index and fast track guidelines.
- Arrival-to-triage times, fast track utilization, and LWBS rates were measured before and after implementation.
Main Results:
- A significant decrease in arrival-to-triage times was observed post-intervention (P < .001).
- Fast track utilization increased by 14% (OR = 1.14), particularly for lower-acuity patients (OR = 1.48).
- LWBS rates remained statistically insignificant, though the acuity of this group decreased.
Conclusions:
- Rapid triage and fast track guidelines effectively reduced patient waiting times.
- The intervention positively influenced nurse-sensitive outcomes related to patient safety and care delivery.
- While LWBS rates did not decrease, acuity within the LWBS population was reduced.
Introduction:
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.
Discussion:
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.
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