Enhancing the Psychiatric Emergency Department Triage Process to Optimize Patient Care

Emergency departments have seen a steady increase in patients presenting with mental health and substance use disorders, leading to overcrowding, prolonged length of stay, patients leaving without being seen, and diminished staff satisfaction. To address these issues, a behavioral health psychiatric emergency department redesigned its triage process to include a fast-track protocol for low-complexity patients, eliminate treatment redundancies, and incorporate a provider in triage to improve patient outcomes and staff satisfaction.

Using the Plan-Do-Study-Act methodology, a revised triage process was implemented to streamline workflows and reduce waste. Time metrics from pre- and postintervention periods were compared.

Reductions were observed in all phases of the ED encounter. The median total length of stay decreased by 110 minutes (38% reduction; P<.001). Time from rooming to provider was reduced from 98 to 43 minutes (56% reduction; P<.001), and the median time from arrival to provider was halved, from 152 to 76 minutes (52% reduction; P<.001). The leaving without being seen rate dropped from 10.5% to 6.3% (40% reduction; P<.001).

The findings suggest that a fast-track triage system, combined with provider in triage, can improve length of stay, reduce leaving without being seen, and enhance staff satisfaction. This model could be beneficial for other emergency departments managing patients with behavioral health concerns.