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A Solution to Improving Emergency Room Efficiency

Long wait times in the City General Hospital's Emergency Room (ER) are a direct

outcome of the ER's constant activity. The goal of this proposal is to lay the groundwork for a

new triage system called Thrive Pathway. Through the use of interdisciplinary methods, this

system improves the quality of care, decreases patient wait times, and boosts patient flow. This

has an effect on the happiness of patients as well as their health results. Improper triage or

excessive waiting times put patients at risk of worsening their conditions. This will ensure

efficient system flow. In order to make the emergency room at City General Hospital more

efficient, this paper will lay out a strategy for doing so by combining individual efforts with

those of other organizations.

Overview

There is a growing problem with overcrowding in emergency departments (EDs) around

the world. The healthcare system as a whole is broken, and this is just a small part of the

problem. Patients run the risk of experiencing prolonged discomfort, inconvenience, and less-

than-ideal results due to emergency care delays. When there are too many people waiting for

treatment in the emergency room, it can make employees unhappy, increase attrition, and make

impatient patients more aggressive and violent (Liu, 2020). Beginning with the patient's arrival,

Thrive Pathway—an interdisciplinary triage system proposed here—involves teamwork among

doctors, nurses, and support staff.

Background and History

The emergency room is frequently the busiest and most complicated part of any

healthcare facility, and the amount of time patients have to wait there has a major influence on

their happiness and health. Patients are ranked according to their severity using the Emergency
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Severity Index (ESI), a regularly used triage system. The development of a rapid, appropriate,

and strategically sound emergency department workflow requires the collaboration of healthcare

professionals from several disciplines. The Thrive Pathway is an interdisciplinary framework

that helps streamline care by differentiating between patients who may not require immediate

medical attention and those who do.

Discussion

In times of medical emergency, the emergency nurse must possess specialized

knowledge, skills, and training to assess and diagnose patients' conditions. There are two triage

systems used in the US: the Emergency Severity Index (ESI) and the Canadian Triage and

Acuity Scale (CTAS). A team of medical experts is entrusted with this responsibility by the

Thrive Pathway, enabling a more rapid and comprehensive evaluation. The Thrive Pathway

approach will ensure that patients receive the proper level of care at the right time, saving time

and resources. Liu (2020) cites research showing that interdisciplinary teams enhance treatment

quality, patient safety, and staff satisfaction. The extra time and money needed to adopt this

strategy could be seen as a drawback. Some worry that the hospital's budget will be

overwhelmed by the costs of training new personnel and hiring additional staff.

Interdisciplinary Plan Proposal

Long wait periods are the norm in the emergency room (ER), which is always bustling

with patients. Both patient happiness and health results are impacted by this. As a result of

improper triage or lengthy wait times to be seen, patients' conditions deteriorate.Reduced wait

times, more patient satisfaction, and better health outcomes are all possible results of a well-

planned, collaborative effort in the emergency room.

Objective
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Implement a strategic, streamlined, and effective emergency room workflow with an

interdisciplinary collaborative approach. The planned initiative, Thrive Pathway, is a

multidisciplinary triage approach designed to speed care by accurately distinguishing between

individuals requiring emergency medical attention and those with non-urgent health concerns

(Davis, 2022). It will aid the ER team in identifying necessary resources and areas that contribute

to waste, decreasing patient wait times, and enhancing good patient outcomes.

Questions and Predictions

1. What distinguishes the existing triage system from this one?

a. There will be more doctor-driven triage than nurse-driven triage. During triage, the nurse

and the doctor will work together to evaluate each patient's acuity rather than the nurse

just examining the patient and finishing the triage (Cicolo et al., 2020).

2. What are the advantages for the personnel and patients of this new triage system?

a. The patient should ideally be checked 20 minutes or less after arriving at the emergency

room. The doctor can decide which ER department the patient will be seen in and what

resources are needed during the examination. This approach will cut waste that could

lengthen hospital patient wait times while concentrating essential resources. Staff can

anticipate what the patient will need and what additional resources may be necessary

because resources are ordered during triage, which reduces waste.

3. What changes to the ER system will be made to allow for this procedure?

a. Using the Emergency Severity Index (ESI), patients will be screened and assigned to

rooms depending on the doctor and nurse's acuity assessment. With one being the most

critical and five being the least essential, the ESI is a five-level triage algorithm that

classifies ER patients based on patient acuity and resource needs. After passing through a
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designated pathway, patients will proceed to one of the three ER locations based on their

ESI. The doctor's directions at the time of triage make up the pathway. This method

reduces the patient's time in the emergency room because they will be prepared with

results when they meet the doctor.

4. Will the budget for more personnel or resources grow due to this change?

a. The budget will see a slight rise. The thrive pathway and the thrive team will be the

names given to this system. In addition to the charge nurse, the Thrive team will require a

dedicated Thrive charge nurse and a triage doctor to oversee the entire system flow

during each shift. Additional float nurses will also be necessary to expedite the process

flow. The Thrive team will use two-way portable radios to improve communication

among themselves. The Passport, a portable training manual, must be made for the

patient and the personnel. This guide will help the patient and staff understand what

resources they will require and where in the emergency room they will be examined. To

accommodate the Thrive route procedure, rooms must be assigned, and places must be

reorganized.

Change Theories and Leadership Strategies

The Lean Theory is one transformation theory that can lead to this multidisciplinary

solution. The Lean Systems Approach (Lean) is a people-based system that focuses on making

defects and inefficiencies visible to empower staff to take action at all levels (Souza et al., 2021).

The ESI system flows, and the Lean principle will improve patient outcomes and satisfaction.

Increasing the efficiency of hospital-based clinical care by applying LH was identified as a

potent strategy for lowering costs and improving outcomes (Tlapa et al., 2020).
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This system transformation can be partially implemented by a collective leadership

approach. Instead of concentrating on a single leader, collective leadership emphasizes a

collection of people who may each bring expertise and experience to pursue a shared objective

(Eva et al., 2021). Since a team of nurses, doctors, and ancillary personnel will be involved in the

triage system, a collective leadership strategy is required to accomplish the shared objective.

The developed solution will also be implemented using the Plan-Do-Study-Act (PDSA)

approach. Because the outcomes of this model can be quantitatively measured, it will aid in

creating a solution (Katowa-Mukwato et al., 2021). After the solution is implemented, the PDSA

model can be used to assess how well it works and whether any more changes need to be made.

The PDSA cycle will also improve multidisciplinary communication, as it will mandate that the

facility's many departments report to the administration on the project's implementation. Monthly

meetings will be held to discuss the plan's accomplishments and shortcomings and any future

adjustments that may be necessary.

Team Collaboration Strategy

Since the ER system is complex and requires cooperation from several levels, forming an

interdisciplinary team is crucial to the new system's operation. Another strategy for enhancing

patient flow is interprofessional cooperation, in which medical professionals with various

backgrounds collaborate to provide the best possible care. Patient safety has been demonstrated

to increase when teams work together, although formal training is necessary due to the

unpredictable nature of the emergency department. Research on interprofessional education and

teamwork has shown benefits in patient satisfaction, work environment, and care quality (Liu,

2020).
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The triage doctor and nurse lead the Thrive team initially. Upon their arrival, the

necessary ESI and resources required are ascertained. Suppose the patient's critical ESI, their

rooming may be initiated immediately based on the triage assessment. If a patient is stable and a

room is not available, they can speed up their treatment while waiting in the waiting area by

completing the Thrive pathway. The Thrive pipeline will consolidate specific departments into

the ER, including the lab, ECG, and radiology. The patient and the staff can gain much by

employing this collaborative approach.

Required Organization Resources

1. Personnel requirements: Every shift change will require a committed triage nurse,

physician, and Thrive charge nurse. A rotating schedule of qualified staff members can

perform this. To accommodate resources, ancillary staff is required. For example, an ER

assistant who works both on the floor and in the ECG room is essential to support the

flow of patients during each shift, as does a dedicated phlebotomist. More float nurses

will be required to speed up the flow, discharge patients, prepare patient rooms, and

support the bedside nurses.

2. Equipment, supplies, and required areas: The current universal computerized system

must be upgraded to accommodate the modifications. Rooms will need to be

reconfigured and redistributed to accommodate ESI levels. An electronic template must

expedite the triage process and provide other departments with patient placements.

The necessary human resources can be transferred and reallocated from other hospital

departments into the emergency room system. The hospital as a whole is reportedly updating its

computerized system quarterly. A minor adjustment will be required to align with the Thrive

pathway system. There won't be any significant building projects necessary to prepare the spaces
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and rooms. This new triage system is not a complete reprocessing effort involving supplies and

equipment as a methodical update for the emergency room.

Proposed Budget

● Four more registered nurses: an estimated $400k annually for each person

● 4 Ancillary Staff: An estimated $50k to $60k per person each year

● ER room modification: estimated annual cost of $10k

● Software development: around $20k annually

In conclusion, the project will first be implemented for the nursing staff only, and the

PDSA cycle will be adjusted to meet the needs of the City General Hospital. Implementing a

collaborative approach to the triage system and the suggested use of the ER system flow will

benefit patients, staff, and the healthcare system as a whole.

References

Cicolo, E. A., Nishi, F. A., & Peres, H. H. C. (2020). Effectiveness of the Manchester Triage

System on time to treatment in the emergency department: a systematic review. JBI

Evidence Synthesis, 18(1), 56-73.

Davis, J. W. (2022). Emergency Department Operational Strategies (Doctoral dissertation,

Walden University).

Eva, N., Cox, J. W., Herman, H. M., & Lowe, K. B. (2021). From competency to conversation:

A multi-perspective approach to collective leadership development. The leadership

quarterly, 32(5), 101346.

Katowa-Mukwato, P., Mwiinga-Kalusopa, V., Chitundu, K., Kanyanta, M., Chanda, D.,

Mwelwa, M. M., ... & Carrier, J. (2021). Implementing evidence based practice nursing

using the PDSA model: Process, lessons and implications. International Journal of Africa

Nursing Sciences, 14, 100261.

Liu, J. (2020). Redesigning an Emergency Department for Interprofessional Teamwork: A

Longitudinal Evaluation of the Impact on Patient Flow and Team Behaviour (Doctoral

dissertation, Karolinska Institutet (Sweden)).

Souza, D. L., Korzenowski, A. L., Alvarado, M. M., Sperafico, J. H., Ackermann, A. E. F.,

Mareth, T., & Scavarda, A. J. (2021, June). A systematic review on lean applications’ in

emergency departments. In Healthcare (Vol. 9, No. 6, p. 763). MDPI.

Tlapa, D., Zepeda-Lugo, C. A., Tortorella, G. L., Baez-Lopez, Y. A., Limon-Romero, J.,

Alvarado-Iniesta, A., & Rodriguez-Borbon, M. I. (2020). Effects of lean healthcare on

patient flow: a systematic review. Value in Health, 23(2), 260-273.