400-O. Triage Redesign: Implementing a 5-Level Triage System
The following Poster Abstracts were presented at the 2005 Emergency Nurses Association's Annual Meeting, September 14-17, Nashville, Tenn. Contact information is provided to facilitate communication with the researchers. Poster abstracts presented at the 2005 ENA Annual Meeting will appear in the December, February, and April issues of the Journal
The ultimate goal of triage is to identify and prioritize patient care needs to determine how soon the patient should see the physician. To meet the demand of the increasing volume of patients at 3 emergency departments of the Montefiore Medical Center in Bronx, NY, a more efficient method to rapidly and accurately sort patients was needed. To address this issue, the Emergency Severity Index (ESI), a 5-level triage system developed by Wuerz and Eitel in 1998, was implemented. The ESI triage acuity rating scale has been shown to be reliable and valid for rapid, accurate triage.
Implementation
In 2002, a multidisciplinary team met to discuss the ESI system and potential implementation. Three issues needed to be addressed immediately to implement the 5-level triage system: work flow design, triage policy, and danger zone vital sign parameters. Work flow was assessed and redesigned accordingly and was completed 6 months prior to implementation of the 5-level triage system. Triage policy was revised to improve efficiency and flow. The team agreed to adopt the danger zone vital sign parameters from the well-established Canadian Paediatric Emergency Department Triage and Acuity Scale. The clinical instructors then met to develop curricula for staff in-service training, including versions for nurse, physician, and support personnel. Staff was educated during a 2-month period, followed by implementation of the 5-level triage system in May 2004.
Outcomes
Preliminary results following implementation of the 5-level triage system indicate that the institution's 3 emergency departments have achieved the following: Standardized triage categorization, increased staff satisfaction with regard to triage accuracy, improved accuracy of triage presentations, and improved triage efficiency. Chart reviews identify documentation as an area for improvement. Through the institution's quality management program, steps are being taken to monitor specific indicators, such as accuracy of triage categorization, triage assessment documentation, and triage wait times.
Recommendations
Implementation of a 5-level triage system, such as the ESI system, has the potential to increase efficiency and accuracy of patient triage and to improve staff satisfaction. Plans for future research at this institution involve evaluation of improvements in triage wait times, including triage-to-physician contact time for patients. In addition, this institution is currently working on a performance improvement plan that will include education to address areas for improvement, followed by chart reviews to assess accuracy of documentation.
Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467
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