Date of Conferral



Doctor of Nursing Practice (DNP)




Janice Long


Overcrowded emergency departments (EDs) are a major problem in the United States resulting in inefficiency in operation and performance. A Southern California hospital ED was the site for this project because it had operated over its maximum capacity during the last decade. Advanced triage protocols integrating standard order sets were implemented to improve quality of care; however, no evaluation of the protocols had been done. The purpose of this project was to evaluate the effect of the advanced triage protocols. Two project questions determined whether advanced triage protocols reduced ED length of stay (LOS), number of patients who left without being seen (LWBS), and improved patient experience. The Lean Principles and the Plan-Do-Study-Act Model for Improvement were used to guide the project. A pre- and post-implementation design found that ED LOS had a significant 17-minute decrease for ESI Level 3 patients (225.7 -± 8.6 minutes vs. 208.8 -± 6.9 minutes, p = .002), and significant 13- minute decrease for ESI Level 4 patients (146.5 -± 1.6 minutes vs. 133.5 -± 1.5 minutes, p =.001). For the ED rate of patients who LWBS, no statistically significant difference was seen between pre- and post- implementation (41/575, 7.13% vs. 46/611, 7.52%). Satisfaction scores were improved by more than 10% after implementation. The advanced triage protocols enhanced front-end throughput operations and patient experience within the ED by allowing triage nurses to initiate orders and begin pain medication. Delivering timely and efficient care to meet various patients' needs has the potential for a positive social change through improved health care outcomes; perception of care; and trust between patients, providers, and the health care system.

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