Screening Questions and the Emergency Department Triage Process: A Quality Improvement Project
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Introduction:
Emergency department triage is a critical process for patient prioritization. However, the accumulation of screening questions unrelated to chief complaints can prolong triage duration, creating a bottleneck that increases pre-triage wait times and the rate of patients who leave without being seen. This quality improvement project consisted of reorganizing triage workflows to decrease triage time measures. This quality improvement project aimed to determine whether reallocating nonessential screening questions from the triage nurse to the bedside emergency nurse would reduce total triage time and improve arrival to triage time thereby decreasing delays in initial nursing assessment.
Methods:
This pre-post intervention analysis was conducted in a 32-bed community emergency department. The intervention involved reallocating screening questions not essential for immediate acuity assessment from the triage nurse to the bedside emergency nurse. Pre-intervention data (September to November 2022; n = 6706) and post-intervention data (September to November 2023; n = 6586) were extracted from the electronic health record. Independent samples t tests and χ2 test analysis were used to compare outcomes. Primary process outcomes were total triage time and arrival to triage time. Leave without being seen was evaluated as a balancing measure.
Results:
Following implementation, mean total triage time decreased from 6.0 to 5.0 minutes (16.7% reduction), whereas mean arrival to triage time decreased from 17.6 to 15.6 minutes (11.4% reduction). The leave without being seen rate decreased from 3.4% to 2.1%, representing a 39.1% relative reduction. Adherence to the revised workflow was 95%.
Conclusion:
Reallocating nonessential screening questions from the initial triage encounter was associated with reductions in triage duration and pre-triage wait times. The intervention was designed to prioritize information necessary for acuity assessment and immediate patient placement while allowing other required screenings to be completed later in the emergency department encounter. The findings support streamlining triage workflows to improve timely access to initial nursing assessment.
