Date of Award


Document Type

Open Access Dissertation


College of Nursing


Nursing Practice

First Advisor

Joan Culley


A need for improvement in the triage process was identified in the ED of a southeastern healthcare facility. Lewin's Change Theory guided the implementation of an evidence-based quality improvement project (QIP) to improve the efficiency of the triage process using and embedded Emergency Severity Index (ESI) triage acuity-level assistant template in the electronic medical record (EMR). The target interventions were ED throughput times, the number of patients left without being seen (LWOT), and RN satisfaction.

Methods included the implementation of education interventions for all ED RNs that included a presentation, use of ESI algorithm badges for each nurse, and weekly case scenarios, where each nurse assigned an ESI triage acuity-level, and provide a rationale for their decisions. Continuing education units were given for the completion of the set of scenarios. Methods that measured the target inventions included pre and post implementation comparison of ED throughput times and the number of LWOT patients. RN satisfaction with the newly embedded triage system was measured through pre and post intervention surveys. The ED throughput times increased approximately 1.5 minutes in relation to the start of the triage process with the implementation. However, the ED throughput times improved for the patients in relation to the amount to of time patients waited from the completion of the triage process until they were placed in the patient care area, a decrease

of approximately 17 minutes. The number of LWOT patients decreased by 2.4% in the implementation period. Approximately 78% of ED nursing staff was satisfied with the EMR's embedded electronic, acuity assistance template. Embedding ESI" improved the efficiency of the triage process, reduced LWOTs and was favorably accepted by the RNs.

The QIP project provided evidence to support the use of an embedded ESI template to improve the efficiency of the triage process. Further research is needed to determine the impact of the electronic, acuity-level assistant template on accurate triage category patient outcomes.


© 2013, Candace Whitfield

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