How Throughput Can Affect the ED Waiting Room

I related to the article “Improving Patient Safety in the ED Waiting Room.”1 The authors were evaluating a new program based on a 5-tier triage system that used a triage reassessment associate (TRA). The goal of the TRA was to help reassess triaged patients while collaborating with the triage nurse to identify deteriorating patients waiting to be seen. This system is very similar to recent changes we made to our triage process in an effort to reduce adverse events.

Our system uses 2 triage nurses and an EMT to help quickly identify patients who need immediate attention from those considered non-urgent. After the initial triage is completed, the second triage nurse carries out a complete triage or in some cases the patient may go directly to a treatment room. In the event of overcapacity like the authors were experiencing, the EMT would help reassess patients who have been triaged and are experiencing extensive delays in treatment times.

I do agree with the authors that this system can help identify deteriorating patients, reduce triage stress level, and reduce the number left without treatment. However, I am left wondering why we are experiencing such overwhelming situations. These types of programs are just band-aids for the overlying issues that face emergency departments nationwide. Even with beefed up triage systems in place, I feel throughput is the major road block to a successful patient outcome. If we are continuously holding admitted patients, our ability to treat new patients is affected significantly. Identifying urgent patients is important but without a bed to treat them in, adverse events will continue to be a major problem facing emergency department nurses.