NUR 598 Week 6 Poster Presentation

Student Name

University of Phoenix

NUR 598 Research Utilization Project (capstone-style project)

Prof. Name

Date

Nurse Practitioner in Triage to Reduce Emergency Department Crowding

Emergency department (ED) crowding can be reduced by placing a Nurse Practitioner (NP) in the triage process. An NP-led triage model allows earlier patient assessment, faster diagnostic workups, timely treatment initiation, and quicker discharge for eligible patients. Evidence suggests this approach can improve patient flow, shorten waiting times, reduce the number of patients leaving without being seen (LWBS), and increase overall patient satisfaction while maintaining safe, high-quality care.

Understanding Emergency Department Crowding

Emergency department crowding is a persistent healthcare challenge that affects hospitals worldwide. As patient volumes continue to rise, many EDs struggle to provide timely care due to limited resources, staffing shortages, and insufficient inpatient bed availability.

Several factors contribute to overcrowding, including:

• Increasing emergency department visits each year

• Shortage of primary care providers

• Growing inpatient admissions

• Limited availability of inpatient beds

• Legal obligations under EMTALA requiring emergency stabilization and treatment

These issues delay patient care and place significant pressure on emergency clinicians.

Impact of Emergency Department Crowding

Overcrowded emergency departments negatively affect both patients and healthcare organizations.

Common consequences include:

• Longer waiting times for critically ill patients

• Ambulance diversion

• Increased risk of medical errors

• Higher rates of patients leaving without treatment

• Extended emergency department length of stay

• Poor patient outcomes

• Increased mortality risk

• Lower patient satisfaction scores

Improving patient throughput is essential to delivering safer, more efficient emergency care.

How a Nurse Practitioner in Triage Improves Patient Flow

Introducing a Nurse Practitioner into the triage area enables qualified providers to begin patient care immediately rather than waiting for an available emergency physician.

Responsibilities of the triage Nurse Practitioner include:

• Performing rapid clinical assessments

• Ordering diagnostic tests

• Initiating evidence-based treatment

• Managing patients with Emergency Severity Index (ESI) Level 2 and Level 3 conditions

• Treating and safely discharging appropriate low-acuity patients

• Coordinating care with physicians and nursing staff

Early intervention reduces unnecessary delays and improves overall emergency department efficiency.

Project Objectives

The primary objective of implementing an NP-led triage model is to improve patient throughput while maintaining high standards of clinical care.

Specific objectives include:

• Improve triage efficiency

• Reduce emergency department crowding

• Initiate treatment earlier

• Optimize resource utilization

• Enhance patient safety and satisfaction

Expected Goals

The proposed intervention aims to achieve measurable improvements across several emergency department performance indicators.

Expected outcomes include:

• Reduced emergency department length of stay

• Shorter time from patient arrival to provider assessment

• Fewer patients leaving without being seen (LWBS)

• Higher patient satisfaction scores

• Improved clinical workflow

• Faster diagnosis and treatment

Note: The original project presented projected outcomes rather than actual clinical results.

Implementation Strategy

Successful implementation requires collaboration among clinical leadership, emergency department staff, and hospital administration.

Key implementation steps include:

• Form a multidisciplinary implementation team

• Develop standardized policies and procedures

• Train physicians, nurse practitioners, and nursing staff

• Evaluate staff competency before launch

• Prepare the physical triage area to support expanded clinical activities

• Monitor performance metrics throughout implementation

Overcoming Barriers to Change

Healthcare organizations often face challenges when introducing new clinical workflows. Common barriers include limited budgets, staffing shortages, high patient acuity, and resistance to change.

Using Lewin’s Change Theory, hospitals can increase staff engagement by:

• Involving frontline staff throughout implementation

• Providing ongoing education and evidence supporting the change

• Encouraging feedback and collaboration

• Offering leadership support during transition

• Recognizing and celebrating implementation successes

Staff participation improves acceptance and long-term sustainability.

Evaluating Project Success

The effectiveness of an NP triage model should be measured using objective quality indicators.

Important performance measures include:

• Emergency department length of stay

• Time from arrival to provider evaluation

• Number of patients leaving without being seen

• Patient satisfaction scores

• Staff feedback

• Operational efficiency

Continuous monitoring helps determine whether modifications are needed.

Maintaining Long-Term Success

If performance metrics demonstrate meaningful improvement, healthcare organizations should integrate the NP triage model into routine emergency department operations.

Long-term sustainability includes:

• Making updated policies permanent

• Continuing quality improvement monitoring

• Reporting outcomes to hospital leadership

• Sharing successful results with professional organizations

• Publishing findings in peer-reviewed healthcare journals

Hospitals may also expand the model into additional patient care pathways after reviewing new evidence.

What If the Project Does Not Produce Desired Results?

Not every quality improvement initiative achieves immediate success. If performance indicators worsen or fail to improve, the implementation team should reassess the intervention.

Recommended actions include:

• Review stakeholder participation

• Gather feedback from staff and patients

• Reevaluate workflow processes

• Conduct an updated literature review

• Follow the Iowa Model of Evidence-Based Practice to redesign the project

If evidence shows the intervention is ineffective or creates unintended consequences, discontinuing the project remains an acceptable evidence-based decision. Even unsuccessful initiatives contribute valuable knowledge for future healthcare improvement efforts.

Communicating Project Outcomes

Transparent communication encourages organizational learning and supports continuous improvement.

Within the Hospital

Project updates should include:

• Weekly implementation meetings

• Department-wide progress reports

• Leadership briefings

• Quality improvement committee reviews

Outside the Hospital

Successful projects should be shared through:

• Peer-reviewed journal publications

• Professional nursing organizations

• Healthcare conferences

• Hospital system leadership

Disseminating findings allows other healthcare organizations to evaluate and adopt effective emergency department strategies.

Key Evidence at a Glance

Research consistently indicates that incorporating advanced practice providers into emergency department triage can:

• Reduce waiting times before provider evaluation.

• Improve emergency department patient flow.

• Lower the number of patients leaving without being seen.

• Increase patient satisfaction.

• Support earlier diagnosis and treatment initiation.

• Enhance operational efficiency without compromising patient safety.

Healthcare organizations should evaluate local staffing, patient volume, and available resources before implementing an NP-led triage model.

Frequently Asked Questions

Does having a Nurse Practitioner in triage reduce emergency department crowding?

Yes. Studies indicate that Nurse Practitioners can improve patient flow by performing early assessments, ordering diagnostic tests, initiating treatment, and managing appropriate patients before physician evaluation.

What are the benefits of NP-led triage?

Major benefits include shorter wait times, reduced emergency department length of stay, fewer patients leaving without treatment, improved patient satisfaction, and more efficient use of healthcare resources.

Which patients can a Nurse Practitioner manage during triage?

Depending on hospital protocols and scope of practice, Nurse Practitioners commonly evaluate patients with Emergency Severity Index (ESI) Level 2 and Level 3 conditions, initiate diagnostic workups, begin treatment, and discharge appropriate low-acuity patients.

What implementation model supports this practice change?

The Iowa Model of Evidence-Based Practice provides a structured framework for implementing, evaluating, and sustaining evidence-based quality improvement initiatives such as NP-led triage.

How should hospitals measure the success of NP triage?

Hospitals should monitor emergency department length of stay, time to provider assessment, patient satisfaction, rates of patients leaving without being seen, workflow efficiency, and overall clinical outcomes.

References

American College of Emergency Physicians. (2011). Definition of boarded patient. https://www.acep.org/clinical—practice-management/definition-of-boarded-patient/

Barish, R. A., McGaughey, P. L., & Arnold, T. C. (2012). Emergency room crowding: A marker of hospital health. Transactions of the American Clinical and Climatological Association, 123, 304–311. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540619/

Bernstein, S. L., Aronsky, D., Duseja, R., Epstein, S., Handel, D., Hwang, U., et al. (2009). The effect of emergency department crowding on clinically oriented outcomes. Academic Emergency Medicine, 16(1), 1–10. https://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2008.00295.x

Doody, C. M., & Doody, O. (2011). Introducing evidence into practice: Using the Iowa Model. British Journal of Nursing, 20(11), 661–664. https://www.researchgate.net/publication/51466031_Introducing_evidence_into_nursing_practice_Using_the_IOWA_model

Government Accountability Office. (2009). Hospital emergency departments: Crowding continues to occur, and some patients wait longer than recommended time frames. https://www.gao.gov/products/gao-09-347

NUR 598 Week 6 Poster Presentation

Harding, K. E., Taylor, N. F., & Leggat, S. G. (2011). Do triage systems in healthcare improve patient flow? A systematic review. Australian Health Review, 35(3), 371–383.

Rowe, B. H., Guo, X., Villa-Roel, C., Schull, M., Holroyd, B., Bullard, M., et al. (2011). The role of triage liaison physicians on mitigating overcrowding in emergency departments: A systematic review. Academic Emergency Medicine, 18(2), 111–120. https://doi.org/10.1111/j.1553-2712.2010.00984.x

Stover-Baker, B., Stahlman, B., & Pollack, M. (2012). Triage nurse prediction of hospital admission. Journal of Emergency Nursing, 38(3), 306–310.

Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, L. Q., et al. (2002). The Iowa Model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13(4), 497–509. https://www.researchgate.net/publication/11580356_The_Iowa_Model_of_Evidence_Based_Practice_to_Promote_Quality_Care

White, B. A., Brown, D. F., Sinclair, J., Chang, Y., Carignan, S., McIntyre, J., & Biddinger, P. D. (2012). Supplemented triage and rapid treatment (START) improves performance measures in the emergency department. Journal of Emergency Medicine, 42(3), 322–328.