A Systematic Approach to Evaluation of Performance Deficiencies in ED Triage

• Nurses are uniquely situated to critically evaluate quality and performance measures, identify opportunities for improvement, and recommend potential corrective inverventions within the emergency department. • Nurses can actively contribute to performance improvements that increase quality of care, improve patient outcomes and satisfaction, and reduce institutional liability and risk. • Establishment of a systematic process to identify deficiencies, evaluate problems, and develop solutions is vital to continuous quality improvement.

Increasing ED crowding has resulted in greater demand and longer time-to-triage and time-to-provider wait times, making accurate triage more important than ever before to avoid poor patient outcomes and possible hospital liability. In one case, a 75-year-old patient presenting with chest pain became unconscious in the ED waiting area after initial registration but before triage. Although resuscitation was attempted, the patient did not survive. Continuous assessment and improvement are needed to streamline the triage process and improve accuracy and efficiency. Because nurses play a vital role in patient triage, they are uniquely positioned to evaluate and enhance the process.

When staff at an 18-bed emergency department in a rural hospital suspected potential quality deficiencies related to extended wait times and patients leaving without being seen, a panel of nurses was formed to characterize the problem by conducting a chart review to develop potential solutions.

The chart review identified a correlation between wait times and patients leaving without being seen during hours of peak demand. Accordingly, the panel collaborated and proposed several interventions to alleviate these problems.

Formation of a panel of skilled nurses to assess problems and recommend potential solutions may represent a useful approach for active nurse participation in quality improvement in the emergency department, thus having a meaningful impact on patient outcomes and hospital liability.