Introducing the Quality at Risk Instrument: A First-of-Its-Kind Solution to Prioritize Safety During Emergency...

Emergency department boarding is a national crisis leading to overcrowding and adverse events, which have increased 78% over 4 years. Boarding leads to negative patient, team member, and system outcomes. Systems have developed process approaches, but no patient-centered method exists to objectively identify those most at risk of developing harm while boarding. This study aimed to describe the 5-phase development and execution of the quality at risk acuity risk instrument.

At a level 1 trauma center in the Midwest, an interprofessional team of emergency department leaders formed to create an objective instrument and process for escalating highest-risk patients to inpatient beds. The team identified current state gaps, developed an instrument, and created standard work to operationalize the instrument in alignment with the 2025 age-friendly measures. Nurse perceptions, throughput, and patient outcome data were evaluated.

After quality at risk implementation, nurses reported improvements in their ability to identify and escalate high-risk patients and were more satisfied with the boarding process overall. Throughput outcomes such as length of stay in the emergency department and hospital were reduced. Mortality and adverse events decreased during the study period.

The quality at risk instrument may be a feasible approach to prioritize patients for inpatient bed placement to reduce harm and improve throughput. Further research is warranted to evaluate instrument reliability and validity.