Reducing ED Crowding Through "Straight Back Triage"

Intervention Title: Reducing Emergency Department (ED) Crowding Through "Straight Back Triage" – William Beaumont Hospital; Royal Oak, Mich.

Goal: Reduce crowding and wait times in the emergency department.

Innovation: Staff introduced a new triage system to quickly pre-screen and categorize patients before sending them to one of three treatment areas to be more fully triaged.

Result: The Straight Back Triage system has had a significant impact on reducing patient wait and throughput times while increasing patient satisfaction. The department's rate of patients who left without being seen (LWBS) decreased from six percent to below one percent, while its diversion rate went from 40 percent to zero. Overall volume in the ED increased, as patients now know they will get timely care at William Beaumont.

Institution: William Beaumont Hospital, Royal Oak3601 W. Thirteen Mile RoadRoyal Oak, MI 48073P: (210) 358-4000

From the C-Suite:

Sometimes the traditional large and crowded ED waiting room is not the best place for patients to wait. Besides feeling like they are being pushed out of sight and out of mind, some patients aren't always being monitored as closely as they should be. We transformed our ED system to work more efficiently and put our patients at the center of operations. ED staff members are now more exposed to those in our care, and patients feel satisfied that they are receiving our attention and the best care quickly.

Val Gokenbach, D.M., R.N.Vice President and Chief Nursing Officer

Profile: William Beaumont Hospital is a 1,061-bed (56 in the ED) community teaching hospital outside of Detroit, Mich.

Clinical areas affected:

  • ED

Staff involved:

  • All ED staff (nurses, physicians and technicians)
  • Registration and clerical staff
  • Transportation staff

Timeline: One-month planning and implementation to change processes

Contact: Val Gokenbach, R.N., M.B.A.Vice President and Chief Nursing Officervgokenbach@beaumonthospitals.comP: (248) 898-1995

Innovation implementation: A frequent problem faced by hospital emergency departments is the patient backup and crowding that can occur in the waiting room. Arriving patients are triaged and then sent to the waiting room where they can experience long wait times and feel "out of sight and out of mind" to the medical staff. At William Beaumont Hospital, patients often faced wait times of up to four hours in the hospital's large and crowded waiting room.

The team at William Beaumont devised a policy to quickly move patients out of the waiting room and "straight back" into treatment areas. Under the new system, when patients present themselves in the ED they are pre-screened by trained technicians and fast-tracked back to one of three areas: Prompt Care, the Pediatric (Peds) ED or the Main ED. Once the patient arrives in one of the three treatment areas, they are fully triaged and can begin receiving preliminary tests while waiting to be seen. To facilitate the new system, a triage care coordinator was hired to monitor and direct patient traffic. Acting as a sort of "air traffic controller," this person tracks open beds and manages patient flow to keep things moving efficiently and effectively.

Immediately assessing and directing patients to the most appropriate areas of the ED has improved patients' perception of the care experience and their satisfaction. It has also improved safety by placing patients in an environment more actively controlled and monitored by staff. The policy has dispersed congestion in the waiting room across the ED, making all staff and areas aware of the existing patient load.

Advice and lessons learned:

  1. Address underlying practices.
  2. Involve all staff early

Cost/benefit estimate: For a minimal investment in staff to handle the new patient load, William Beaumont experienced a substantial increase in patient satisfaction and safety, while ED volumes grew as the hospital's reputation for timely care spread throughout the community.

All information is current as of June 2008 unless otherwise specified. Please note our Terms of Use.