Advanced triage protocol for patients presenting to the emergency department with abdominal pain

Purpose of Project: Emergency Department (ED) overcrowding is a widespread issue, which affects the safety and quality of care due to prolonged wait times, diagnosis, and treatment (Erenler et al., 2014). Length of stay (LOS) and left without being seen (LWBS) rates are key indicators of ED efficiency and quality of care (Mentzoni et al., 2019). The project site’s average LOS and LWBS rates are significantly higher than local and national averages, demonstrating a quality improvement gap to be addressed. A quality improvement project to improve triage practices for stable adult patients with abdominal pain complaints was proposed. An advanced triage protocol, consisting of standing order sets with rapid diagnostic testing and care, was implemented. This intervention intended to expedite care, reduce LOS, reduce LWBS, and ultimately improve efficiency and patient satisfaction in the era of ED overcrowding. Methodology: Through a quality improvement process, the advanced triage protocol for patients with abdominal pain complaints was implemented for one month in the ED triage area of an urban academic medical center. Retrospective chart reviews pre-and post the one-month implementation period were conducted to gather and analyze data to determine whether the intervention was effective in reducing LOS and LWBS rates in eligible patients. Results: This project resulted in a reduced mean LOS in eligible patients by 53 minutes (p=0.012), which was statistically and clinically significant in that it aids the project site ED in addressing the overcrowding crisis. The LWBS rate decreased from 11% to 10.4% post-intervention (p=0.344), which was not statistically significant and is far from the national benchmark goal of 2%, however the slight improvement in LWBS rates may still be clinically significant in improving the safety and quality of care. Implications for Practice: By implementing an advanced triage protocol consisting of triage nurse initiated standing order sets, this practice change improved patient flow and throughput in the ED. Advanced triage protocols and nurse initiated standing order sets are new evidence-based practices that will help to minimize the negative consequences related to long wait times, LOS, and overcrowding by reducing LOS and LWBS rates. The findings of this project demonstrated that this practice change can positively impact LOS and, residually, improve the efficiency, throughput, quality, safety, costs, and perception of care satisfaction in the ED (Hwang et al., 2016).DNPIncludes bibliographical reference