Improving emergency department triage quality improvement project

Background: Healthcare presents challenges that require nursing professionals to continually evaluate their practice. Overcrowding in the emergency department (ED) has become a worldwide public health problem over the last decade (DiSomma et al., 2015). ED overcrowding occurs when the demand for emergency resources exceeds those available. ED triage decisions are based on resource utilization. ED overcrowding implies the need for accurate triage decisions to ensure that care is delivered in a time-sensitive manner for those who are ill. In order to provide the best care in a timely manner, for our patients, improvements in current emergency triage practice are necessary. Variation in the use of the Emergency Severity Index (ESI) triage algorithm among emergency department nurses has been found to be a significant problem. If the triage nurse misinterprets a patient's presentation, the result can be improper allocation of resources or mistriage. Mistriage occurs when ESI is not utilized properly. Mistriage has been associated with delay of care and treatment (Yurkova, 2011). Mistriage further contributes to the ED overcrowding crisis. In order to improve care, improvements in triage practice must be made. Most emergency departments provide and require ESI education. Education programs vary among emergency departments. Programs vary with regard to who is educated, length of education, and methods utilized to deliver education. Improved ESI education is necessary to improve triage practice. Purpose: The purpose of this Doctorate of Nursing Practice (DNP) quality improvement project was to improve current ED triage practice. The authors of the ESI triage algorithm recommended that the rate of ED mistriage should be kept at less than 10% (Gilboy, Tanabe, Travers, & Rosenau, 2011). The researcher measured improvements by a decrease in the rate of mistriage. The researcher created this project in an attempt to remedy the burden of overcrowding in the ED. The researcher has identified a need for an ED triage practice improvement. Methods: The researcher utilized a quasi-experimental design. Participants consisted of a convenience sample of ED registered nurses. The intervention was a nurse driven evidence-based quality improvement project in the form of a triage education program. The researcher developed an ED triage YouTube education program and provided laminated ESI resource cards for participants. Additional intervention included mentoring of participants and participation in an interactive Facebook page dedicated to emergency department triage over a 4-week period. Evaluation: The researcher measured a decrease in the number of mistriages through the evaluation of 20 case-based triage scenarios in pre, post, and post posttest evaluations. The ED triage case-based scenarios were developed by the experts of the ESI research team. The researcher cleaned, coded, and checked the data for normality of distribution and outliers. The researcher handled missing data through the use of multiple imputation. The researcher utilized descriptive and inferential statistics (frequencies, means, and standard deviations) to describe differences. Clinical Implications: The DNP quality improvement project will increase knowledge, which will improve current ED triage practice. Improvements in ED triage practice will be evident by improved accuracy of ESI triage level assignation. Improvements in ESI triage level assignation will ensure the delivery of timely care in the emergency department, ultimately having a positive impact on the ED overcrowding crisis.