Implementation of triage standing order at an emergency department

Chest pain has been found to be a frequent cause of visit to the emergency department (ED). Chest pain is the second most presenting complaint in the emergency department in the United States, accounting for about 7.6 million visits annually. Literature suggests that use of standing orders/protocol in the ED for initiation of patient evaluation and care prior to the patient evaluation by a physician of advanced practice provider can help to reduce emergency room length of stay and physician to disposition times. This evidence-based quality improvement study aimed to assess the impact of the implementation of a triage nurse standing order in the emergency department. The target population was patients above 18 years presenting with chest pain to the emergency department. The targeted outcomes were physician to disposition time and emergency department length of stay. The outcomes were measured using retrospective pre-implementation and post-implementation chart review. SPSS 29 was used for the statistical analysis. Chi square test of independence was used to compare data collected pre-implementation and post-implementation of the intervention and same revealed a clinical significance of a slight decrease in the emergency department length of stay especially in the group of patients that stayed more than eight hours in the emergency department. This quality improvement project highlights the importance of the use of standing orders for patients presenting to the emergency department with chest pain.