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Impact of ED Triage Symptom- and Travel-Screening Strategy

Published:December 31, 2020DOI:https://doi.org/10.1016/j.jen.2020.12.001
      Dear Editor:
      Thank you for publishing the article entitled “Can you catch it? Lessons learned and modification of ED triage symptom- and travel-screening strategy” by Schwedhelm et al.
      • Schwedhelm M.M.
      • Herstein J.J.
      • Watson S.M.
      • et al.
      Can you catch it? Lessons learned and modification of ED triage symptom- and travel-screening strategy.
      The authors’ subsequent discussion on a recent Emergency Nurses Association podcast episode provided some additional helpful information (“Behind the Research in November Journal of Emergency Nursing,” 2020). The successful efforts to identify, isolate, and inform on patients with potentially communicable exposure, thereby reducing staff exposures, certainly warrant applause. However, certain additional pieces of information may be helpful for organizations discerning whether or not to apply this approach. These include, but are not limited to, clarification of the staffing model, further details regarding the 75% compliance rate, and the observed pre- and postimplementation metrics for (1) door-to-triage times, (2) door-to-provider times, and (3) left without being seen (LWBS) rates, at a minimum.
      The article mentioned the use of a 24/7 “greeter nurse.” Was the greeter nurse a distinctly separate person from the nurse performing triage duties? If yes, was a cost analysis done to evaluate the return on investment of this additional role, which is approximately 4.2 full-time equivalents, against the total cost of exposure, which would include time off and potential turnover?
      For more than a decade, there has been ongoing discourse regarding what questions belong in an arrival/triage process and what questions should occur later in a visit.
      • Foley A.L.
      • Durant J.
      Let’s ask that out front: health and safety screenings in triage.
      More recently, the 2020 Emergency Nurses Association General Assembly adopted a resolution to further opine on screening questions during triage.
      Emergency Nurses Association
      Resolution GA20-04: patient screening in the emergency department.

      ENA General Assembly meeting—afternoon session YouTube page. Screening resolution passage at 1:14:54 of 2:17:15 minute mark. Emergency Nurses Association. September 16, 2020. Accessed December 1, 2020. https://www.youtube.com/watch?v=6qbEIEz_Peo&t=1583s

      Identifying and isolating patients with potentially communicable diseases are certainly crucial. Although the authors discussed potential delays for the patients who had been positively screened, it is also important to note what impact, if any, occurred on preprovider evaluation times for all patients. Specifically, did the creation of this process lengthen the door-to-provider interval for all patients or have a negative impact on the LWBS rates?
      Finally, can the authors further detail the “approximate 75% compliance rate”? Are there separate compliance rates for outpatient clinics compared with the emergency department? Were there any trends observed among the ED patients who did not have the screening completed?
      In summary, it would be beneficial if future articles discussing the use of screening questions before provider evaluation also identify the impact of the process, if any, on ED throughput metrics, including, but not limited to, the door-to-provider interval and LWBS rate.—Nicholas Alen Chmielewski, DNP, RN, CEN, CENP, NEA-BC, FAEN, Senior Managing Consultant, Berkeley Research Group, LLC, Emeryville, CA; E-mail: . ORCID identifier: https://orcid.org/0000-0002-6543-9669.

      Disclaimer

      The views and opinions expressed are those of the author and do not necessarily reflect the opinions, position, or policy of his employer or its other employees and affiliates.

      References

        • Schwedhelm M.M.
        • Herstein J.J.
        • Watson S.M.
        • et al.
        Can you catch it? Lessons learned and modification of ED triage symptom- and travel-screening strategy.
        J Emerg Nurs. 2020; 46: 932-940https://doi.org/10.1016/j.jen.2020.03.006
        • Emergency Nurses Association
        ENA podcast. Behind the Research in November Journal of Emergency Nursing.
        (Published November 16, 2020. Accessed December 1, 2020.)
        • Foley A.L.
        • Durant J.
        Let’s ask that out front: health and safety screenings in triage.
        J Emerg Nurs. 2011; 37: 515-516https://doi.org/10.1016/j.jen.2011.06.013
        • Howard P.K.
        Do we need triage?.
        J Emerg Nurs. 2011; 37: 597https://doi.org/10.1016/j.jen.2011.08.008
        • Emergency Nurses Association
        Resolution GA20-04: patient screening in the emergency department.
        in: 2020 General Assembly Handbook. Emergency Nurses Association, 2020: 48-53
      1. ENA General Assembly meeting—afternoon session YouTube page. Screening resolution passage at 1:14:54 of 2:17:15 minute mark. Emergency Nurses Association. September 16, 2020. Accessed December 1, 2020. https://www.youtube.com/watch?v=6qbEIEz_Peo&t=1583s

      Linked Article

      • Response to Chmielewski Letter
        Journal of Emergency NursingVol. 47Issue 2
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          We would like to thank Dr Chmielewski for his comments on our article “Can you catch it? Lessons learned and modification of ED triage symptom- and travel-screening.”1 Dr Chmielewski raises some important clarifying points that we hope will be addressed below.
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      • Can You Catch It? Lessons Learned and Modification of ED Triage Symptom- and Travel-Screening Strategy
        Journal of Emergency NursingVol. 46Issue 6
        • Preview
          Efficient identification and isolation of patients with communicable diseases limits exposure to health care workers, other patients, and visitors. In August 2014, our team developed and implemented an algorithm to triage suspected cases of Ebola virus disease in a midwestern United States emergency department and outpatient clinics based on patient travel history and symptoms. Here, we present the lessons learned and modifications to update the tool.
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