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Adv Emerg Nurs J. 2012 Jan-Mar;34(1):65-74. doi: 10.1097/TME.0b013e3182435543.

The effectiveness of a provider in triage in the emergency department: a quality improvement initiative to improve patient flow.

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Presbyterian Healthcare, Charlotte, North Carolina, USA.


Hospital emergency departments (EDs) throughout the United States are faced with overwhelming challenges due to the high demand for services, an increasing number of visits, overuse and misuse of services, and escalating healthcare costs. The result of this situation is that EDs are overcrowded, patients are experiencing long wait times, ambulances are being diverted, admitted patients are being boarded, and patients in need of emergency medical care are leaving without treatment. The purpose of this article is to present a quality improvement initiative designed and implemented to improve patient flow through an ED by redesigning the triage process to increase the efficiency and timeliness of initial patient contact with a licensed medical provider, increasing patient satisfaction, and decreasing the number of patients who leave without being seen. To accomplish these goals, a nurse practitioner/physician assistant medical provider was reallocated to the triage area to perform an initial assessment and initiate diagnostic studies. The results of this initiative have proven to be positive in goal attainment. The time from patient arrival to initial contact with a licensed medical provider has decreased from 75 to 25 min. The percentage of patients who leave without being seen has decreased from 3.6% to 0.9%.

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