Making more nurses, one minute at a time: an efficiency and quality improvement project in emergency triage

Emergency triage is a short-duration, high-volume process so small reductions in the time taken to triage one patient can have large repercussions on the total amount of triage time. At the emergency department of a large inner-city hospital, an efficiency and quality improvement project was undertaken to reduce the time taken to safely triage patients and optimise the use of triage nurses' time. The project involved removing processes that did not contribute to the primary aim of triage, supporting individual triage nurses to improve their performance where needed, and optimising the triage process. A 44% reduction in mean triage episode time was seen, equating to 18,000 minutes of triage nurses' time saved every month. This near doubling of triage capacity was associated with an improvement in triage accuracy. The article describes the project, which used lean management principles and statistical process control methods, and discusses its implications for emergency triage.