Triage Reliability in the Emergency Department - Impact on Patient Flow

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Edward Popovich
Sterling Enterprises International Inc./Sterling Academy

Dave Eitel, M.D.
Sterling Academy

ESI Triage is utilized to screen patients to determine both urgency of patient needs and the resource demand on an Emergency Department. Triage impacts patient flow and care. How can an organization assess and improve Triage reliability?

The CGH ED Throughput Six Sigma Black Belt Team was assigned the task of educating and improving the service delivery performance of their Community General Hospital's Emergency Department, with focus in ED length of stay. During the Define/Measure phase of the project it was realized that the approach to patient triage - ESI Triage - would play a significant role in the flow of patients into the ED. Early on the triage nurses at CGH participated in a study of the reliability of assignments of ESI triage levels wherein significant and worrisome variability in the assignment of ESI levels amongst the triage nurses was discovered. To gain more insight into the consistency of the application of ESI triage levels by the triage nurses the Black Belt students then analyzed and evaluated the distribution of ESI triage levels by each triage nurse over a period of one month. All analyses were completed using statistical software.

The purpose of this presentation is two-fold:

  1. To report the results of their findings.
  2. To describe a methodology that could readily be followed by any interested ED Medical Director, Nursing Supervisor, or Hospital Administrator to understand and improve Triage reliability.