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Emergency Department Undertriage: Using Multidisciplinary Case Review to Drive Quality Improvement.

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Pediatric Quality & Safety
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Summary
This summary is machine-generated.

A multidisciplinary team-based review process reduced clinically important undertriage in the pediatric emergency department (PED) by 14%. This quality improvement initiative enhanced patient safety by ensuring timely evaluations and treatments for high-risk pediatric patients.

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Area of Science:

  • Emergency Medicine
  • Pediatric Care
  • Healthcare Quality Improvement

Background:

  • Triage is critical for prioritizing patient evaluation in emergency settings.
  • Undertriage, or underestimating patient acuity, poses significant safety risks.
  • In pediatric emergency departments (PEDs), undertriage leads to delays in essential interventions.

Purpose of the Study:

  • To describe a multidisciplinary, team-based case review process.
  • To decrease the rate of clinically important undertriage in a PED.
  • To improve the accuracy and safety of the triage process.

Main Methods:

  • Defined clinically important undertriage for patients with Emergency Severity Index (ESI) scores of 4 or 5 requiring admission or specific treatments.
  • Utilized an electronic health record tool to identify potential cases for review.
  • Conducted monthly reviews by nurse-provider dyads and multidisciplinary teams to assess triage accuracy.

Main Results:

  • Reviewed 543 patient visits between September 2023 and September 2024.
  • Implemented interventions led to a 14% decrease in the rate of clinically important undertriage.
  • Observed a significant centerline shift, indicating sustained improvement.

Conclusions:

  • Clinically important undertriage is a key metric for enhancing PED triage processes.
  • Multidisciplinary, team-based interventions are effective in reducing undertriage rates.
  • The implemented process improved patient safety and care delivery in the PED.