The emergency department (ED) at Mat-Su Regional Medical Center (MSRMC) continues to see record volumes pushing capacity year after year - a trend EDs are experiencing across the U.S. To combat overcrowding, MSRMC formed a triage committee composed of front-line staff and charge nurses that set three key goals: increase triage accuracy, ensure that lower acuity patients’ care is completed in under two hours, and expedite screening and care for the most critical and high-risk patients. The only stipulations were that solutions could not include construction or hiring additional staff.
Tackling Triage Accuracy
Recognizing the pivotal role of triage accuracy, the committee introduced a comprehensive virtual course focused on triage and the updated Emergency Severity Index® (ESI®) 5th edition. This initiative, mandatory for all nurses, led to a remarkable 19% increase in triage accuracy. Monthly chart audits coupled with constructive feedback have been instrumental in ensuring sustained competency among the staff.
Innovative Staging Solution
Focusing on care for lower acuity patients required out of the box thinking and the bravery to attempt new ideas. After several initiatives stalled, the committee ultimately decided to request temporary, adjustable walls for the ED lobby to create an internal rapid intervention and treatment zone (RITZ). With this strategy, they have successfully reduced the average length of stay for ESI 4 and 5 patients to an impressive 106 minutes. This ingenious approach not only enhanced patient outcomes but also expedited the overall discharge process.
A Paradigm Shift in Patient Assessment
One of the most impactful changes initiated by the committee was the 'nurse-first' approach in patient assessment. By ensuring that medically trained professionals are the first point of contact for patients, the team eliminated the risk of oversight in discerning high-risk presentations.
The idea of moving a registered nurse to the front desk and removing them from their immediate team was initially met with some resistance from charge nurses who felt if could be a “waste of a nurse”, so the committee moved forward with a two-month trial period. During peak hours, when the department is overcrowded and patients need to wait in the lobby for care, a pivot nurse greets every patient for assessment and is able to accelerate treatment for those with a high-risk presentation. Since implementation, the ED has seen improvements in expedited screening and care over pre-pilot practices.
“Once the ED staff saw the impact this pivot nurse role played in expediting the care of our most critical and high-risk patients,” explains committee chair Melissa Imgrund, MSN, RN, “we had buy-in from the team. This role that initially received resistance is now embraced as essential.”
The triage committee is continuing to improve processes, and they claim that their success is directly related to the peer-to-peer decision making that enables the committee to employ a grass-roots approach by the people doing the work so that they are able to be nimble and make change through flexibility and innovation.
“The leadership of this organization encouraged the formation of the committee, and supported each of their goals and implementation,” says Imgrund, “even when ideas failed and needed to be rerouted through trial and error. I believe that the courage, creativity, and passion for excellent patient care fueled this committee and made it wildly successful.”
Triage Committee: Melissa Imgrund, MSN, RN, CEN, CPEN, Anna Breen, RN, Erin Farr, RN, Jessica Cheshier, RN, Kai McGrath, RN, Libby Bengtson, RN, Mikaela Hull, RN, Thor Tabladillo, RN, Vaughn Kelly, RN
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