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Pediatric Respiratory Score in the Triage Form
Insights
A new pediatric respiratory score improved triage accuracy for children with respiratory distress, reducing wait times for those needing pediatric intensive care unit transfer. This quality improvement initiative enhanced emergency department efficiency.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Initiatives
- Triage Accuracy
Background:
- Respiratory distress is a frequent pediatric emergency department presentation.
- A retrospective review found 22% of pediatric patients transferred to the ICU for respiratory issues were undertriaged (ESI 3 or 4).
- Undertriaged patients experienced significantly longer provider wait times (1 hr 15 min vs. 43 min).
Purpose of the Study:
- To implement and evaluate a pediatric respiratory score for emergency department triage.
- To reduce wait times for pediatric patients with respiratory distress requiring ICU transfer.
- To decrease door-to-provider and door-to-transfer times.
Main Methods:
- A 15-week quality improvement initiative was conducted.
- Emergency department staff received training on the new pediatric respiratory score.
- Data collected included score utilization, triage accuracy (ESI 1 or 2 for ICU transfers), and door-to-provider/transport times.
Main Results:
- 86.5% of 59 transferred respiratory distress patients were correctly triaged (ESI 1 or 2), an improvement from 78% the prior year.
- Average door-to-provider time decreased to 15 minutes with the score, versus 20 minutes without.
- Average door-to-transport time remained under 10 hours for both groups.
Conclusions:
- The pediatric respiratory score effectively enhances patient assessment at triage.
- Implementation of the score led to improved wait times for pediatric respiratory patients needing ICU transfer.
- The initiative demonstrated success in optimizing emergency care for critically ill children.
Introduction:
Respiratory distress is a common pediatric presentation in emergency departments requiring prompt treatment to avoid poor outcomes. A retrospective chart review at a large community hospital pediatric emergency department revealed that 22% of walk-in patients 0 to 12 years old, who were transferred to a pediatric intensive care unit for a respiratory-related complaint, were undertriaged with an emergency severity index score of 3 or 4. The transferred patients from the hospital's pediatric emergency department with emergency severity index scores of 3 or 4 had an average wait of 1 hour and 15 minutes to see a provider compared with those with an emergency severity index level 1 or 2 who had an average wait of 43 minutes. Implementation of a pediatric respiratory score in emergency department triage formed the basis of a 15-week quality improvement initiative. The aim was to reduce wait times for pediatric patients requiring pediatric intensive care unit care owing to respiratory distress and to decrease door-to-provider and door-to-transfer times.
Methods:
Staff were trained over 1 week on respiratory score use. Weekly data were collected on nurse respiratory score utilization for all pediatric respiratory patients, percentage of respiratory patients transferred to a pediatric intensive care unit with the correct emergency severity index level of 1 or 2, and average door-to-provider and door-to-transport times.
Results:
A total of 59 patients were transferred for respiratory distress; 86.5% of these were correctly triaged with an emergency severity index level 1 or 2, which was an improvement from 78% the previous year. Average door-to-provider time was 15 minutes for transferred patients with a respiratory score and 20 minutes for those without. Average door-to-transport time was less than 10 hours for both groups.
Discussion:
The pediatric respiratory score can improve patient assessment at the point of triage. Since implementing the pediatric respiratory score, wait times have improved for patients transferred to a pediatric intensive care unit with a respiratory complaint.
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