Immediate Triage Increases ED Throughput

Title:
Implementing Immediate Triage to Improve ED Operations

Result:
Allenmore Hospital decreased ED boarding time for patients by 40 minutes – from an average of 71 minutes down to 31 minutes. Total average throughput (i.e. total time spent in the ED) for admitted patients dropped from 275 to 208 minutes. The triage process also improved the throughput for patients that did not need hospital admission. Average throughput time for a discharged patient dropped from 162 to 148 minutes.

Institution:
Allenmore Hospital
1901 S Union Ave
Tacoma, WA 98405

Profile:
Allenmore Hospital is a community-based hospital with 100 beds and two nursing units plus an intensive care unit.

Contact:
Lois Catts, R.N., M.S.N.
Quality Management Consultant for Clinical Effectiveness
P: (253) 697-1888            
Lois.Catts@multicare.org

Innovation Implementation:
Like many emergency departments (EDs) across the country, Allenmore Hospital’s ED struggled with overcrowding, excessive wait times and patients leaving without being seen. For patients admitted to the hospital, some were being boarded in the ED for 24-48 hours before moving to inpatient units.

Looking at patient flow in the ED and identifying where the hold-ups were in providing effective patient care for critically ill patients, the Allenmore team saw the triage process as a key operational bottleneck. To better determine which patients needed to be seen immediately, the ED restructured the triage and registration process. The team reorganized the process so patients are now put through the triage process first upon entering the hospital. This new system allows ED staff to easily identify which patients need to “go to the front of the line.”

Similarly, the new triage process helps ED staff determine how to effectively treat patients that are in need of ‘minimal intervention’ – moving them in and out of the ED quickly and efficiently by treating them in other parts of the hospital which frees up beds in the ED.

By better understanding the demand of critically ill patients, the ED was able to prioritize care. Additionally, (the hospital set up a system) of mandating 30 minute limits on how long an admitted patient could be boarded in the ED. This time limit helped expedite the throughput process and improve communication among hospital departments.

Allenmore Hospital decreased ED boarding time for patients by 40 minutes – from an average of 71 minutes down to 31 minutes. Total average throughput (i.e. total time spent in the ED) for admitted patients dropped from 275 to 208 minutes. The triage process also improved the throughput for patients that did not need hospital admission. Average throughput time for a discharged patient dropped from 162 to 148 minutes.