Providing an Evidence-Based Medical Screening Examination On Patients Who Present to the Emergency Department with Non-Emergent Complaints: a Quality Improvement Initiative

Problem Emergency Department (ED) overcrowding is a growing concern for hospitals across the US. ED overcrowding contributes to prolonged wait times and an increase in the number of patients who leave before or without being seen (LWBS). The number of patients using the ED for non-emergent complaints is expected to continue to rise and some hospitals are utilizing a different model to deliver care (Nash, Nguyen, & Tillman 2009). The problem statement described in this project is: In (P) adults utilizing the ED for non-emergent complaints at a local hospital in the southern US, (I) will providing a mid-level provider in triage to perform an evidence-based medical screening examination (MSE) on non-emergent patients (C) when compared to no MSE being performed, result in (O) less wait times in the ED and decreased number of patients who LWBS. Purpose The purpose of this capstone project was to designate a mid-level provider in triage to perform an evidence-based MSE on adults assigned a non-emergent acuity level in the emergency department. Goal/Objectives The goal of this project was to decompress the ED and increase efficiency by allowing non-emergent patients to receive care in the most appropriate healthcare venue. The objectives of this project were to: evaluate whether placing a mid-level provider in triage to perform an evidence- based MSE reduced length of stay and the number of patients who LWBS, educate stakeholders about the new model of care, redirect non-emergent patients to the appropriate venue of care, and re-evaluate wait times in the ED and the number of patients who LWBS post-implementation of the MSE process. Plan The plan involved hiring four mid-level providers and placing them in triage to perform an evidence-based MSE on non-emergent patients. Financial counselors were hired as they would be instrumental in discussing treatment options for those patients being screened to another venue of care. A quasi-experimental study utilizing a pre and post design and retrospective data collection was used to determine if placing a mid-level provider in triage made a difference in wait times and patients who LWBS. Outcome and Results The data collection included ED length of stay and the percentage of patients who LWBS and was collected on 100 non-emergent patient\u27s pre and post implementation of the MSE (n=200). A one-sample t-test analyzing the length of stay was significant with a mean of 3.409 (p=0.000, CI 95%), lower limits 3.409 and upper limits 3.6909. A paired samples t-test analyzing the means of the LWBS rates pre and post placing the midlevel in triage was significant with a mean of 3.28 (p=0.000, CI 95%, SD 1.96) lower limits 2.034 and the upper limits was 4.52. Placing the mid-level provider in triage significantly decreased the number of patients who LWBS. The LWBS rate pre-MSE was 6.71 and 3.43 post MSE. A one-way ANOVA between groups comparison of length of stay by shift was not statistically significant with p=0.131, but was clinically significant