Nursing Dissertation Chapter Paper on How to Improve the Triage Process to Decrease Patient Throughput

How to Improve the Triage Process to Decrease Patient Throughput

            Today, many healthcare facilities are yet to establish effective ways of dealing with overcrowding in the emergency rooms. The high demand for emergency care services necessitates the need for hospitals to implement measures that enhance patient throughput. One of the most effective ways that the physicians can use to improve the process is the triage process that helps in classifying the patients according to their healthcare needs. The process reduces unnecessary delays that decrease the effectiveness of nurses in providing sound medical attention to the patients. In the process, a pre-triage nurse is able to increase the effectiveness of service delivery by evaluating the patients to determine the urgency of medical attention for each of them (Eitel et al., 2010). The evaluation helps the nurses determine the medical personnel that the patients are likely to see depending on the acuity of the conditions. This paper discusses the effectiveness of triage process in enhancing the quality of medical services provided to the patients who demand urgent medical attention.  Literature reviews from different studies are used to enhance the effectiveness of the triage process in enhancing patient throughput.

            A study by Martin et al. (2014) indicates that the triage process influences the attitudes of nurses. The study was aimed at investigating whether there was a connection between the attitude of the nurses as a result of their experience in ED and their ability to triage patients. The authors claim that the efficiency of nurses in providing health care services in the emergency rooms is enhanced by the use of triage process, especially in those involved in emergency severity index scores. The study shows that the accuracy of emergency severity index (ESI) scores influences the motivation of the physicians in carrying out their work. The exploratory design study was based on data collected from 64 nurses working in three emergency departments with more than 1600 triage events (Martin et al., 2014). To determine the link between the attitude of nurses and triage experience, the researchers used Pearson’s correlation. The experience of the nurses was found to have insignificant link to the accuracy of the ESI score. The authors concluded that the experience of the nurses in the emergency department did not matter in the triage process. The ED nurses have the capacity to triage patients appropriately in the emergency departments. The study disputed the notion that the attitude or experience of nurses in ED has an impact on the accuracy of triage process. From the study, it is evident that the effectiveness of triage process in reducing patient throughput does not depend on the experience of ED nurses. However, the effectiveness of the triage process can only be achieved if it is carried out accurately.

            To ensure that the triage process is effective, it is important for the healthcare personnel to ensure that there are minimal errors. Among the major factors that lead to inaccuracy of the processes include interruptions. A study carried out by Johnson et al. (2014) indicates that interruptions during the triage process are the primary causes of delays and errors. One of the most important aspects that contribute to accuracy of the emergency care services is the ability to give the patients the appropriate medical attention. Interrupting the triage process reduces the ability of ED nurses to provide the most effective medical attention to the patients. To carry out accurate evaluations, the nurses need to go through various steps. However, when the process is interrupted, it is impossible for them to achieve their objectives. The interruptions may lead to misdiagnosis, thus affecting the quality of services provided to the people. At times, it is impossible to carry out a triage process without any interruptions but their frequency affects the concentration of the ED nurses. In most cases, the types of interruptions that affect the process are those that are not related to patient care. The interruptions do not only cause delays in the medical car, but also offend the patients.

            Apart from non-medical interruptions, the triage process is affected by crowding. The inability of the medical practitioners to contain patient throughput may lead to crowding that affects the ability of the nurses to provide high quality services (Casalino et al., 2013). Throughput is one of the factors that indicate the effectiveness of the emergency department quality. The time interval reflects the work dynamics of the medical teams. To contain the issue of crowding, the medical personnel need to identify strategies of profiling the patients according to the medical attention. A study carried out by Howell (2015) indicates that telephone triage is important for low-acuity cases. To reduce the crowding, Vezyridis and Timmons (2014), suggest that healthcare facilities need to transform their structure focusing on the clinical, special, and organizational issues.  .  

            It is important for nurses to improve their skills in carrying out the triage process to improve patient throughout in the emergency care. One of the ways that the nurses can use to improve their skills is through online learning. The evolution of information technology in the modern era makes it possible for the healthcare personnel to improve their skills by taking online tutorials. A study carried out by Rankin, Then and Atack (2013) indicates that registered nurses can use online sources to improve their knowledge and skills in healthcare activities. The study used web-based workshop on triage and acuity scale that last six weeks. The study concluded that online training is helpful in improving the skills and competency of the employees. Through the online training, the nurses can understand the significance of complaint-specific protocols in promoting the efficiency of the ED nurses (Castner et al., 2013). However, the effectiveness of the protocols is reduced by the regulatory environment where the application of the protocols may be enhanced or inhibited.  The impact of the complaint-specific protocols on the efficiency of ED nurses makes it necessary for the regulators of the healthcare sector to standardize the environment (Cassidy-Smith, Baumann & Boudreaux, 2007). Apart from improving the skills and knowledge of ED nurses, computer technology can be used to predict the magnitude of decrease of length of stay for additional healthcare providers (Day, Al-Roubaie & Goldlust, 2013).

            In conclusion, the triage process can improve patient throughput by reducing the frequency of interruptions and using modern technology. The use of computers is less costly compared to the other interventions that may include activities, such as hiring new staff and increasing the facilities. One should bear in mind that the emergency care might be needed in areas where resources are inadequate. It is therefore important to reduce the cost of providing healthcare services by embracing modern technology in the triage process.  


Casalino, E., Choquet, C., Bernard, J., Debit, A., Doumenc, B., Berthoumieu, A., & Wargon,       M. (2013). Predictive variables of an emergency department quality and performance indicator: a 1-year prospective, observational, cohort study evaluating hospital and   emergency census variables and emergency department time interval            measurements.Emergency Medicine Journal30(8), 638-645.

Cassidy-Smith, T. N., Baumann, B. M., & Boudreaux, E. D. (2007). The disconfirmation paradigm: throughput times and emergency department patient satisfaction. The    Journal of emergency medicine32(1), 7-13.

Castner, J., Grinslade, S., Guay, J., Hettinger, A. Z., Seo, J. Y., & Boris, L. (2013).            Registered nurse scope of practice and ED complaint-specific protocols. Journal of      Emergency Nursing39(5), 467-473.

Day, T. E., Al-Roubaie, A. R., & Goldlust, E. J. (2013). Decreased length of stay after      addition of healthcare provider in emergency department triage: a comparison        between computer-simulated and real-world interventions.Emergency Medicine     Journal30(2), 134-138.

Eitel, D. R., Rudkin, S. E., Malvehy, M. A., Killeen, J. P., & Pines, J. M. (2010). Improving          service quality by understanding emergency department flow: a White Paper and        position statement prepared for the American Academy of Emergency Medicine. The         Journal of emergency medicine,38(1), 70-79.

Howell, T. (2015). ED Utilization by Uninsured and Medicaid Patients after Availability of          Telephone Triage. Journal of Emergency Nursing.

Johnson, K. D., Motavalli, M., Gray, D., & Kuehn, C. (2014). Causes and occurrences of interruptions during ED triage. Journal of Emergency Nursing,40(5), 434-439.

Martin, A., Davidson, C. L., Panik, A., Buckenmyer, C., Delpais, P., & Ortiz, M. (2014). An        examination of ESI triage scoring accuracy in relationship to ED nursing attitudes and       experience. Journal of Emergency Nursing40(5), 461-468.

Rankin, J. A., Then, K. L., & Atack, L. (2013). Can emergency nurses’ triage skills be        improved by online learning? Results of an experiment. Journal of Emergency    Nursing39(1), 20-26.

Vezyridis, P., & Timmons, S. (2014). National targets, process transformation and local     consequences in an NHS emergency department (ED): a qualitative study. BMC         emergency medicine14(1), 12.