Medicine and Health Sciences Commons^™

Refining Triage Documentation Practices In A Metropolitan Emergency Department, Jack A. Moody

Master's Projects and Capstones

Problem California ranks ninth nationwide for its lengthy emergency department wait times, presenting a pressing challenge for healthcare facilities. Context This quality improvement project, set in the emergency department of a large urban hospital in the Bay Area, aimed to address this issue by targeting workflow efficiency through the reduction of triage times. Intervention The intervention centered on implementing changes to the triage documentation, informed by staff feedback obtained through an opinion survey. Proposed modifications included the elimination of redundant questions, consolidation of related categories, and a logical reorganization of triage topics. Measures Key measures utilized in the project included …

Optimization Of Triage Documentation In A Large Urban Emergency Department, Monica Reynoso-Prieto

Master's Projects and Capstones

Problem California ranks ninth nationwide in terms of longest emergency department wait times. The project aims to reduce patient triage times by refining the workflow of triage documentation, achieved through strategic rearrangement of triage documentation questions. Context This quality improvement project took place in the emergency department of a large urban Bay Area hospital. Intervention The intervention was implementation of changes to the triage documentation based on staff feedback from an opinion survey, such as: elimination of redundant questions, consolidation of related categories, and logical reorganization of triage topics. Measures Measures used in the project were triage times and pre …

Improving Triage Accuracy In The Emergency Department, Catriona E. Clohessy

Master's Projects and Capstones

Problem: Hospital Z’s emergency department was experiencing a triage inaccuracy rate that exceeded the accepted national benchmark of 10%. This quality improvement project aimed to reduce triage inaccuracy to less than 10% in the emergency department at Hospital Z, through improved education and availability of supplemental reference materials.

Context: This quality improvement project was conducted in a 40 bed emergency department at Hospital Z. This microsystem serves a diverse patient population from the surrounding community that experience a variety of conditions requiring emergency medical intervention.

Interventions: Clinical Nurse Leader nursing students partnered with unit leadership to create a new ESI …

Improving Triage Accuracy In The Emergency Department, Vince Harrington

Master's Projects and Capstones

Problem: Mistriage was occurring at higher than acceptable rates. In turn, this caused poor staffing levels and patient outcomes. This project seeks to improve triage accuracy according to the Emergency Nurses Association’s (ENA) Emergency Severity Index (ESI) algorithm.

Context: The Emergency Department in a prominent bay area hospital that was experiencing high rates of mistriage.

Interventions: The staff nurses were required to attend a retraining on the Emergency Nurses Association (ENA) Emergency Severity Index (ESI) algorithm. Following the retraining, a follow up online exam with sample patients must be passed at 100%. Furthermore, badge buddies containing the ESI algorithm will …

Improving Triage Accuracy In The Emergency Department, Maia E. Baglin

Master's Projects and Capstones

A Northern California emergency department (ED) faced increased triage inaccuracy. An analysis of 400 random ED visits from January to April 2023 discovered a 23% mistriage rate, with under- and over-triage rates at 16.25% and 6.75%, respectively. Mistriage creates an imbalance in unit acuity, leading to inappropriate staffing levels. Potential breaks in the triage process, include inaccurate triaging by the screener or triage nurses, as well as delays in the providers inputting initial orders, leaving patients waiting without appropriate care orders. An educational training focusing on the updated Emergency Nurses Association Emergency Severity Index (ESI) algorithm version 5 was mandated. …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Pregnancy Loss In The Emergency Department, Gudrun Reiterhiltebrand

Master's Projects and Capstones

Abstract

The aim of this project is to improve the care for patients experiencing pregnancy loss in the emergency department (ED). Objectives are to enhance understanding of staff about the patients’ experience and their knowledge on how to best care for emotional needs, thus improving quality of patient care, work satisfaction, knowledge, confidence and comfort levels, while decreasing experienced stress. The project was implemented in a midsized community hospital with 117 beds, which discharged 74 patients with “interrupted pregnancies” over the previous year from the ED. The project was directed toward nurses, doctors, care partners, chaplains, and social workers. The …

Debriefing In The Emergency Department, Alyssa Johnson

Master's Projects and Capstones

Emergency Department (ED) staff are repeatedly exposed to high stress situations and as a result suffer from compassion fatigue, secondary traumatic stress, symptoms of post-traumatic stress disorder, burnout and high turnover rates. Staff turnover is costly to the health system in the form of training new staff and potential poor patient outcomes due to under staffing or inexperience of staff. Based on a survey about debriefing, Level 1 Adult and Pediatric Emergency Department staff reported 81% felt there was inadequate support for critically stressful events that occur. Debriefing was identified by 75% of the staff as an option for support. …