Nurses Reduce Percentage of Patients Leaving ED Unseen

Problem

The Emergency Department at University Medical Center Brackenridge was experiencing a high percentage of patients who left without being seen by a health care provider (APRNs and physicians). Our goal was to improve the patient experience and decrease the percentage of patients leaving the ED without being seen.

Intervention

Pictured from left to right in the triage area at UMCB: George Barron, improvement advisor, Luisa Silva, RN, clinical supervisor, Taya Murray, UMCB ED clinical manager, Dr. Ziebell, UMCB ED medical director and Stephanie Stager, UMCB ED clinical manager.

Pictured from left to right in the triage area at UMCB: George Barron, improvement advisor, Luisa Silva, RN, clinical supervisor, Taya Murray, UMCB ED clinical manager, Dr. Ziebell, UMCB ED medical director and Stephanie Stager, UMCB ED clinical manager.

A nurse-led team reconfigured the triage process in November 2014. Under the old system, patients were triaged in a specified triage room and then sent back to the general waiting area to wait for an emergency room bed. Under the new system, known as “Quick Look,” triage is started in the triage room (weight, height, chief complaint, vitals, acuity level), but the rest is completed in a new space called the Continuing Care Area. Patients are then assigned a room and seen by a physician or advanced practice nurse practitioner.

Results

The new triage system has improved patient satisfaction and has decreased the percentage of patients leaving the ED without being seen by a physician or nurse practitioner from 5.21 percent in July 2014 to 1.50 percent nine months later in March 2015. The “arrival to provider” time improved the median time from 28 minutes (September 2014) to 19 minutes (December 2015). During this same period, the likelihood of former patients recommending the UCMB ED also increased from 52 percent to 75 percent.