Triage Staff Research Articles

Using emergency department data to define a 'mental health presentation' - implications of different definitions on estimates of emergency department mental health workload.

Objective This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58-0.59) and between the AIHW definition and review by EPS of 0.58 (0.57-0.58). Conclusions The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs.

Patient stratification based on the risk of severe illness in emergency departments through collaborative machine learning models

ObjectivesEmergency department (ED) overcrowding presents a global challenge that inhibits prompt care for critically ill patients. Traditional 5-level triage system that heavily rely on the judgment of the triage staff could fail to detect subtle symptoms in critical patients, thus leading to delayed treatment. Unlike previous rivalry-focused approaches, our study aimed to establish a collaborative machine learning (ML) model that renders risk scores for severe illness, which may assist the triage staff to provide a better patient stratification for timely critical cares. MethodsThis retrospective study was conducted at a tertiary teaching hospital. Data were collected from January 2015 to October 2022. Demographic and clinical information were collected at triage. The study focused on severe illness as the outcome. We developed artificial neural network (ANN) models, with or without utilizing the Taiwan Triage and Acuity Scale (TTAS) score as one of the predictors. The model using the TTAS score is termed a machine-human collaborative model (ANN-MH), while the model without it is referred to as a machine-only model (ANN-MO). The predictive power of these models was assessed using the area under the receiver-operating-characteristic (AUROC) and the precision-recall curves (AUPRC); their sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score were compared. ResultsThe study analyzed 668,602 ED visits from 2015 to 2022. Among them, 278,724 visits from 2015 to 2018 were used for model training and validation, while 320,201 visits from 2019 to 2022 were for testing model performance. Approximately 2.6% of visits were by severely ill patients, whose TTAS scores ranged from 1 to 5. The ANN-MH model achieved a testing AUROC of 0.918 and AUPRC of 0.369, while for the ANN-MO model the AUROC and AUPRC were 0.909 and 0.339, respectively. Based on these metrics, the ANN-MH model outperformed the ANN-MO model, and both surpassed human triage classification. Subgroup analyses further highlighted the models' capability to identify higher-risk patients within the same triage level. ConclusionsThe traditional 5-level triage system often falls short, leading to under-triage of critical patients. Our models include a score-based differentiation within a triage level to offer advanced risk stratification, thereby promoting patient safety.

Effect of Paramedics in Emergency Department Triage on Ambulance Patient Offload Times

Background: Emergency Department (ED) overcrowding limits patient care in the prehospital and hospital system. A program was implemented to decrease the time to patient handoff from EMS arrival to ED staff, also known as the delivery interval and total turnaround interval. Paramedics were added to the ED ambulance triage staff to receive verbal reports and perform certain tasks done traditionally by nurses. We hypothesized adding paramedics to the ED triage process would reduce delivery interval times and total turnaround times. Methods: This was a retrospective observational study comparing delivery and turnaround intervals for patients brought to the ED by ambulance, before and after the addition of a paramedic in triage. The study period included all adult ED patients brought in by ambulance between 11 AM and 11 PM. Pediatric patients (<21 years old), direct-to-inpatient interfacility transfers, and critical patients requiring immediate care in the resuscitation area and thus bypassing normal triage processes were excluded. The data was analyzed with two-sample t-tests with a confidence interval of a = 0.05. Results: Delivery interval pre-implementation of the program was 15:48 minutes (95% CI [15:28, 16:09]) compared to 14:04 minutes (95% CI [13:44, 14:25]) post-implementation. The mean turnaround interval pre-implementation was 35:21 minutes (95% CI [35:01, 35:42]) and 36:04 minutes (95% CI [35:40, 36:29]) post-implementation. The mean difference for the delivery interval was shortened by 01:44 minutes (p<0.0001; 95% CI [01:15, 02:13]). The mean turnaround interval increased by 00:43 seconds (p<0.01; 95% CI [00:11, 01:16]). Conclusion: Staffing a paramedic in ED triage decreased delivery interval by 1:44 minutes but did not affect ambulance turnaround times. Further research is needed to determine if the decrease in delivery interval improved patient outcomes and ways to translate the time saved in the delivery interval to total turnaround times.

Spine surgeon triage of new patient referrals: quantification of surgical conversion rate by clinic referral source

BACKGROUND CONTEXTIn an effort to efficiently deliver high-value spine surgical care, spine surgery clinics may triage new patient referrals. A triage system with attending surgeon review of referred patient images may improve the surgical conversion rate (SCR) of a spine surgical clinic, and shift the distribution of new patients in clinic toward those most likely to derive benefit from surgery. PURPOSETo quantify SCR and number of triage steps by referral source in a tertiary referral spine clinic where all referrals are triaged by attending surgeons. DESIGNAll spine surgery clinic patients seen for a new patient visit (NPV) at an academic medical center over a one-year period had their triage process and outcome (surgery or no surgery) reviewed. PATIENT SAMPLEThe 1398 new adult patients seen for elective spine pathology were queried. OUTCOME MEASURESSCR was defined as the percentage of new patients who underwent elective spine surgery within 18 months of NPV. Triage steps were defined as an action item by triage staff (ie, obtaining patient records) or by the patient (ie, undergoing additional imaging). METHODSAll new patient visits were evaluated for referral source, number of triage steps, and triage outcome. Time from referral to NPV, and time from NPV to surgery were also recorded. SCR, triage steps, and time-intervals were calculated for each surgeon and referral source and compared. Statistical analysis of variance (ANOVA) was used to ascertain differences. RESULTSThe overall SCR for the 4-surgeon group was 41.6%. This ranged among the surgeons from 24.7% to 60.1%. The referral sources with the highest SCR were in-system spine advanced practice providers (APPs) and in-system physical medicine and rehabilitation providers. Spine APPs also demonstrated the smoothest referral process, requiring the fewest steps. CONCLUSIONSOur findings provide a framework for assessment of triage processes at other institutions, as well as the impact of upgrades to our triage process as we work to improve triage efficiency. In the present study, referrals from providers familiar with spine pathology resulted in the highest SCR and fewest triage steps.

Exploring Diagnostic Precision and Triage Proficiency: A Comparative Study of GPT-4 and Bard in Addressing Common Ophthalmic Complaints.

In the modern era, patients often resort to the internet for answers to their health-related concerns, and clinics face challenges to providing timely response to patient concerns. This has led to a need to investigate the capabilities of AI chatbots for ophthalmic diagnosis and triage. In this in silico study, 80 simulated patient complaints in ophthalmology with varying urgency levels and clinical descriptors were entered into both ChatGPT and Bard in a systematic 3-step submission process asking chatbots to triage, diagnose, and evaluate urgency. Three ophthalmologists graded chatbot responses. Chatbots were significantly better at ophthalmic triage than diagnosis (90.0% appropriate triage vs. 48.8% correct leading diagnosis; p < 0.001), and GPT-4 performed better than Bard for appropriate triage recommendations (96.3% vs. 83.8%; p = 0.008), grader satisfaction for patient use (81.3% vs. 55.0%; p < 0.001), and lower potential harm rates (6.3% vs. 20.0%; p = 0.010). More descriptors improved the accuracy of diagnosis for both GPT-4 and Bard. These results indicate that chatbots may not need to recognize the correct diagnosis to provide appropriate ophthalmic triage, and there is a potential utility of these tools in aiding patients or triage staff; however, they are not a replacement for professional ophthalmic evaluation or advice.

2049 Evaluating the rate, timeliness and accuracy of centralised Clinical Frailty Score documentation at a major NHS A&amp;E department

Abstract Introduction Between 5-10% of patients attending the emergency department (ED) are elderly patients living with frailty. NHS England now recommends that all patents aged &amp;gt;65 presenting to acute care should have a Clinical Frailty Score documented within 30 minutes of arrival. We audited the CFS documentation from the Electronic Patient Record (EPR) for patients aged &amp;gt;65 presenting to our local E.D. Methods Our baseline audit looked at patients aged &amp;gt;65 presenting to our ED from 01/09/23-07/09/2023 (n=430). We extracted data for rate and timeliness of documentation from EPR. To calculate accuracy, we compared the documented scores from ED triage staff, with that of our therapist led Frailty Intervention Team (FIT). We excluded patients not assessed by the FIT. We then re-audited the data for 3 separate weeks after delivering a tailored teaching session for band 6 and 7 nurses, and introduction of an educational poster. Results We found exceptional baseline compliance and timeliness of CFS scoring with a 97% documentation rate with a median time of 31 mins from presentation. When assessing accuracy of triage nurse CFS documentation, we found that 42% of patients fell into a lower category of frailty when compared to scores allocated by the FIT. Following teaching sessions and poster education, we observed no improvement in this. Conclusion Our audit identified an overall excellent baseline compliance and timeliness in EPR documentation of CFS scores despite the department’s heavy workload. We noted a significant under-recognition of frailty at ED triage compared to specialist therapist scoring. Despite delivering education sessions and introduction of an educational poster there is still significant room for improvement in accurate identification of frailty with the CFS.

Assessing the utility of artificial intelligence throughout the triage outpatients: a prospective randomized controlled clinical study.

Currently, there are still many patients who require outpatient triage assistance. ChatGPT, a natural language processing tool powered by artificial intelligence technology, is increasingly utilized in medicine. To facilitate and expedite patients' navigation to the appropriate department, we conducted an outpatient triage evaluation of ChatGPT. For this evaluation, we posed 30 highly representative and common outpatient questions to ChatGPT and scored its responses using a panel of five experienced doctors. The consistency of manual triage and ChatGPT triage was assessed by five experienced doctors, and statistical analysis was performed using the Chi-square test. The expert ratings of ChatGPT's answers to these 30 frequently asked questions revealed 17 responses earning very high scores (10 and 9.5 points), 7 earning high scores (9 points), and 6 receiving low scores (8 and 7 points). Additionally, we conducted a prospective cohort study in which 45 patients completed forms detailing gender, age, and symptoms. Triage was then performed by outpatient triage staff and ChatGPT. Among the 45 patients, we found a high level of agreement between manual triage and ChatGPT triage (consistency: 93.3-100%, p<0.0001). We were pleasantly surprised to observe that ChatGPT's responses were highly professional, comprehensive, and humanized. This innovation can help patients win more treatment time, improve patient diagnosis and cure rates, and alleviate the pressure of medical staff shortage.

Addressing challenges in telephone triage for outpatient oncology care: A data-centred digital routing solution.

591 Background: As cancer care shifts to a predominately outpatient model, there is growing recognition that optimizing communication between patients and their care providers between scheduled visits can improve efficiency and patient outcomes. Princess Margaret Cancer Centre (PM), which sees over 80,000 patients annually, operates with many parallel telephone triage lines as the primary means of patients-provider communication. When a patient needs to contact their care team, they are instructed to leave a voicemail and wait for a response. In a high-volume setting this model presents many challenges to the patient experience, provider efficiency, and patient safety. The purpose of this pilot project was to design, implement, and assess the feasibility of a digital channel for patients to reach their care team. Methods: We used a human-centred design approach to develop a new digital triage service. First, we analyzed manually collected triage call data over a one-year period to understand the most common patient queries of the telephone triage service. Through co-design, a new digital-triage service was conceptualized and prototyped. Subsequently, we tested a data-centred digital routing algorithm for patient concerns and symptoms. To evaluate implementation and assess feasibility, we collected usage data, satisfaction surveys, and conducted staff shadowing and interviews. We used PDSA cycles to refine user experience and clinical workflows. Results: Patient adoption of digital triage increased continuously over 9 months, with volumes surpassing voicemail after four months: over the last four months digital triage has encompassed on average 63% of the total request volumes. The response rate to patient surveys was 21%. Patients indicated being very satisfied or satisfied (74.4%), neutral (6.7%), and dissatisfied or very dissatisfied (18.9%). Interviews with leading triage staff suggest the digital channel improves triage efficiency and redirecting/escalation by providing structured and complete patient queries. Conclusions: The pilot highlights the feasibility and acceptability of a digital-triage service in a comprehensive cancer care setting. By leveraging digital tools and real-time data, PM addressed the challenges of telephone triage, enabling a more efficient process to respond to patients’ needs, while demonstrating high adoption and patient satisfaction. Subsequent work will expand the use of digital triage to all disease sites across the cancer centre, and create foundational workflows and technology for proactive care models, such as Remote Patient Monitoring.

Staff experiences of integrating community and secondary care musculoskeletal services: A qualitative investigation.

Integrated models of care intend to provide seamless and timely access to health and social care services. This study investigated the integration of musculoskeletal services across community and secondary care boundaries, including the introduction of a single point of access from which patients were triaged. Staff (n=15) involved in service development and delivery were interviewed about how, why and to what extent integration impacted service delivery. The analysis focused on staff experiences of using an on-line patient self-referral form and co-located clinics to enhance decision-making in triage, and on the provision of educational materials and de-medicalising language in patient consultations to support self-management. Single point of access, including online self-referral, were operationalised during data collection, but co-located clinics were not. Triage staff explained that the volume of referrals and quality of information provided in online self-referrals sometimes constrained decision-making in triage. Secondary care staff discussed concerns that the single point of access might not consistently identify patients with hard to diagnose conditions that require timely surgical intervention. This concern appeared to constrain staff engagement with integration, potentially inhibiting the delivery of co-located clinics. However, triage staff accessed support to inform secondary care referral via alternate modes. Patient circumstances, for example, need for reassurance, necessitated multiple self-management strategies and innovative approaches were developed to provide patients ongoing and professionally led support. Findings emphasise that restructuring services requires engagement from diverse stakeholders. Collaborating with stakeholders to address their concerns about the impact of restructures on well-established pathways may help cultivate this engagement.

P019 Improving new patient appointment utilisation in rheumatology advanced practice physiotherapy

Abstract Background/Aims Long Rheumatology waiting lists in the UK were further affected by the COVID-19 pandemic; resulting in negative impacts upon the timeliness and efficiency of patient care. The use of Advanced Practitioners within Rheumatology care pathways has been shown to be safe and effective; they can support the Rheumatology workforce and expedite care where patients are appropriately triaged to them. As part of a service provision change in a NHS Trust, an Advanced Practice Physiotherapist (APP) post was funded with the intent to harness these benefits. Initial utilisation of the APP appointments within the Rheumatology provision was found to be low and could be improved. A Quality Improvement (QI) Project was initiated, with the aim to increase APP appointment utilisation to at least 85% over a period of four months, and for at least 75% of these appointments to contain patients who had been appropriately triaged. Methods The ‘Model for Improvement’ was chosen as the QI approach. The project was led by an APP. Firstly, a stakeholder analysis was performed to identify staff with influence and interest in the project. A root cause analysis found lack of awareness of triaging clinicians and challenges with booking processes as potential reasons for lower-than-expected appointment utilisation. Change interventions were devised and tested over three Plan, Do, Study, Act (PDSA) cycles. PDSA one developed communication with booking and triage staff to clarify these processes with them. PDSA two educated clinical staff about the APP role, triage criteria and the booking procedures confirmed in PDSA one. PDSA three focused upon sustaining change by reinforcement of the topics established in PDSA two among staff. Outcome measures used were the percentage of available APP appointments utilised per week, and the percentage of these which contained patients who were appropriately triaged. Results APP appointment utilisation increased from a mean of 22% pre-project to 61% during the change intervention period. Sixty-three patients were seen over the 17-week change intervention period; of which 86% had been appropriately triaged. Data showed that 70% of the patients directed to the APP were managed by them (24% discharged and 46% reviewed). Of the remaining patients, 13% were followed up by a Rheumatologist, 12% did not attend and 5% had an alternative outcome such as awaiting advice. Conclusion This QI project led to an improvement in Rheumatology care provision locally. Engagement with support staff, education of clinical staff and implementation of clear standard operating procedures improved the utilisation of the Rheumatology APP resource. Results suggest that the APP role was effective locally in managing appropriately triaged patients, without a negative effect on patient care or other services. Continuing to improve utilisation will support management of the Rheumatology waiting list and improve patient care. Disclosure S. East: None. G.J. McCall: None. P.A. Watson: None. P. Smith: None.

To ascertain the awareness among Triage Staff about Clinical Conditions treated in the department of Hand Surgery from their Referral Pattern: A Cross Sectional Observational Study in a Tertiary Care Center

To ascertain the awareness among Triage Staff about Clinical Conditions treated in the department of Hand Surgery from their Referral Pattern: A Cross Sectional Observational Study in a Tertiary Care Center

A Telephone Triage System for Patients Calling with Symptoms of a Posterior Vitreous Detachment

The purpose of the study was to develop a simple telephone questionnaire, without physical examination input, that predicts which patients calling with symptoms of a posterior vitreous detachment (PVD) have a retinal tear (RT) or rhegmatogenous retinal detachment (RD). Prospective cohort (quality improvement) study. All patients with symptoms consistent with a PVD calling a major academic ophthalmology department over a 4-month period in 2020 and who were seen on follow-up within 1.5 months (211 screened and 193 included). A comprehensive telephone questionnaire assessing for RT/RD risk factors was administered by telephone triage staff to all patients calling with symptoms of flashes, floaters, or curtain/veil in their vision. Multivariable logistic regression was used to determine risk factors most predictive of having an RT/RD during the add-on visit. Risk factor odds ratios were used to develop an RT/RD risk score. Development of a clinical risk score for having an RT/RD at the add-on visit after telephone triage. Approximately 55% of patients were previously established in the retina clinic, 26% were new to the department, 19% were previously established in the comprehensive clinic, and 7% had an RT/RD at the add-on visit. Out of 23 questions and 70 prespecified possible answers from the telephone questionnaire, the final clinical risk score for RT/RDs was derived from 7 questions and 15 possible answers. The simplified questionnaire can be administered quickly by telephone operators without any reference to physical examination or the patient's chart. The receive-operator curve for our final multivariable logistic regression and clinical risk score models have an area under the curve of > 0.90. Using a conservative clinical risk score, approximately 50% of all patients without an RT/RD can be safely seen nonurgently. Progressively higher scores can be used to determine relative urgency of an appointment. To our knowledge, this is the first study to predict risk of an RT/RD in a patient calling with symptoms consistent with a PVD without reference to the patient's physical examination or chart. Our clinical risk scoring system can be used to determine urgency of an add-on appointment and increase the number of low-risk patients with symptomatic PVDs who are scheduled routinely. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion.

BackgroundThe Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, the DOTTS should be adopted in the daily care process by triage staff.ObjectiveThe primary aim was to evaluate the degree of implementation (ie, normalization) of the DOTTS, and the secondary aim was to evaluate which lessons can be learned from its current implementation in Dutch hospitals.MethodsAn evaluation study with a mixed methods design was performed. All triage staff in 9 Dutch hospitals that implemented the DOTTS before September 1, 2019, were invited to complete the Normalization Measure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory (NPT). This self-reported questionnaire provides insights into the work people do in order to integrate and embed new practice in routine care. The NPT is based on the following 4 constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Within the questionnaire, each construct is represented by 4-7 questions. Questions are scored on a 5-point normalization process scale. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, the questionnaire findings were discussed during a focus group. Template analysis following the 4 constructs was used for analyzing the results of the focus group.ResultsOverall, 173 of 294 (58.8%) triage staff members completed the NoMAD questionnaire, and 90.2% (156/173) of the participants had used the DOTTS for over 6 months. The digital application was used as much as possible or always by 137 of 173 (79.2%) participants. The overall normalization process score was 3.77 (SD 0.36). The constructs coherence, cognitive participation, collective action, and reflexive monitoring scored 4.01 (SD 0.47), 4.05 (SD 0.45), 3.5 (SD 0.45), and 3.72 (SD 0.47), respectively. Analysis of the focus group discussion showed that the added value of the DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team was important for facilitating normalization. Support from the medical staff and proper use by all disciplines involved in the triage were seen as facilitating factors. Participants appreciated training and evaluation, and indicated a need for ongoing training and evaluation in relation to goal achievement.ConclusionsThe DOTTS has been integrated into normal care in daily practice. Evaluation by the NoMAD questionnaire provided a positive overall score. These results are in line with or, in some aspects, better than the results of other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team, and implementation plans that are tailor made in the practical context of the hospital.

Physician-Specific Utilization of an Electronic Best Practice Alert for Pediatric Sepsis in the Emergency Department.

Early recognition of sepsis remains a critical goal in the pediatric emergency department (ED). Although this has led to the development of best practice alerts (BPAs) to facilitate screening and bundled care, research on how individual physicians interact with sepsis alerts and protocols is limited. This study aims to identify common reasons for acceptance and rejection of a sepsis BPA by pediatric emergency medicine (PEM) physicians and understand how the BPA affects physician management of patients with suspected sepsis. This is a qualitative study of PEM physicians in a quaternary-care children's hospital. Data were collected through semistructured interviews and analyzed through an iterative coding process until thematic saturation was achieved. Member checking was completed to ensure trustworthiness. Thematic analysis of PEM physicians' rejection reasons in the electronic health record was used to categorize their responses and calculate each theme's frequency. Twenty-two physicians participated in this study. Seven physicians (32%) relied solely on patient characteristics when deciding to accept the BPA, whereas the remaining physicians considered nonpatient factors specific to the ED environment, individualized practice patterns, and BPA design. Eleven principal reasons for BPA rejection were derived from 1406 electronic health record responses, with clinical appearance not consistent with shock being the most common. Physicians identified the BPA's configuration and incomplete understanding of the BPA as the biggest barriers to utilization and provided strategies to improve the BPA screening process and streamline sepsis care. Physicians emphasized the need for further BPA education for physicians and triage staff and improved transparency of the alert. Physicians consider patient and nonpatient factors when responding to the BPA. Improved BPA functionality combined with measures to enhance screening, optimize sepsis management, and educate ED providers on the BPA may increase satisfaction with the alert and promote more effective utilization when it fires.

Charting Practices to Protect Against Malpractice: Case Reviews and Learning Points.

IntroductionMedical documentation issues play a role in 10–20% of medical malpractice lawsuits. Inaccurate, incomplete, or generic records undermine a physician’s defense and make a plaintiff’s lawyer more likely to take on a case. Despite the frequency of documentation errors in malpractice suits, physicians receive very little education or feedback on their documentation. Our objective in this case series was to evaluate malpractice cases related to documentation to help improve physicians’ documentation and minimize their liability risks.MethodsWe used Thomson Reuters Westlaw legal database to identify malpractice cases related to documentation. Common issues related to documentation and themes in the cases were identified and highlighted.ResultsWe classified cases into the following categories: incomplete documentation; inaccurate text; transcription errors; judgmental language; and alteration of documentation. By evaluating real cases, physicians can better understand common errors of other practitioners and avoid these in their own practice.ConclusionEmergency physicians can reduce their liability risks by relying less on forms and templates and making a habit of documenting discussions with the patients, recording others’ involvement in patient care (chaperones, consultants, trainees, etc.), addressing others’ notes (triage staff, nurses, residents, etc.), paying attention to accuracy of transcribed or dictated information, avoiding judgmental language, and refraining from altering patient charts.

Improving annual albuminuria testing for individuals with diabetes

BackgroundAnnual albuminuria screening detects the early stages of nephropathy in individuals with diabetes. Because early detection of albuminuria allows for interventions that lower the risk of developing chronic kidney disease,...

390 A Telemedicine Emergency Provider in Triage Improves Patient Experience, Staff Satisfaction, and Operational Metrics

Emergency department (ED) patient volume surge can prolong waiting room (WR) times which delays care and disposition. A telemedicine emergency provider (EP) in triage can initiate care without the limitations of physically placing one in the WR -- space, repeat interviewing, and EP availability. This study compared telemedicine EP in triage to standard WR operations during surge periods in terms of ED patient experience, ED staff satisfaction, and operational metrics.

MP58-10 QUALITY IMPROVEMENT INITIATIVE TO OPTIMIZE OUTPATIENT TRIAGE WORKFLOW AND REDUCE BURNOUT

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety IV (MP58)1 Sep 2021MP58-10 QUALITY IMPROVEMENT INITIATIVE TO OPTIMIZE OUTPATIENT TRIAGE WORKFLOW AND REDUCE BURNOUT Loren Smith, Hannah Moreland, and Timothy Averch Loren SmithLoren Smith More articles by this author , Hannah MorelandHannah Moreland More articles by this author , and Timothy AverchTimothy Averch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002088.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our rapidly expanding urology practice increased to eight providers in under two-years’ time with a corresponding growth in patient volume. Triage personnel reported an untenable escalation in workload with mounting burnout representing an opportunity for process improvement. The SMART (specific, measurable, achievable, realistic, timely) aim for this project was to reduce the frequency and duration of triage calls, increase the appropriateness of call content, and improve the well-being of the triage staff. METHODS: Starting September 2020 using Plan-Do-Study-Act (PDSA) quality improvement (QI) methodology, a multiprofessional team iteratively identified systems-level processes available for refinement, leading to optimized triage workflow. Quantitative and qualitative data were obtained sequentially through five phases. Data were collected through a multidisciplinary approach including triage call logs, direct observation, and one-on-one collaboration sessions. Triage personnel were surveyed periodically using an anonymous, validated, repeatable instrument. RESULTS: After five PDSA cycles, triage noted a reduction in call volume by 403 calls (20.3% reduction) with a median call duration of 58 seconds (21.1% reduction), down from a baseline of 1,986 calls with median call duration 73.5 seconds. Restructuring and refinement of the clinical phone tree (PDSA 1-2) and standardized management of non-urgent calls to triage not warranting triage attention (PDSA 3) contributed to the improvement. Notably, five call categories deemed inappropriate for triage were eliminated after the application of PDSA process improvement. Further modifications based on collected survey responses aimed to create a culture of recognition. They included triage interior redesign (PDSA 4), patient paperwork reallocation outside of triage (PDSA 5), and a patient education handout covering a common triage call topic (current PDSA). The latter refinements increased job satisfaction (20%), workload manageability, and fostered greater congruence between job expectations and triage duties. CONCLUSIONS: Small changes to the structure of the work and communication environment resulted in measurable improvements in both call volume and employee satisfaction. Relatively few systems factors were responsible for a majority of triage concerns. Further interventions, including implementing a monthly QI meeting, optimizing use of the patient portal, and improving staffing resource allocation are needed to actualize further employee satisfaction. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e992-e992 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Loren Smith More articles by this author Hannah Moreland More articles by this author Timothy Averch More articles by this author Expand All Advertisement Loading ...

The Application of Hazard Vulnerability Analysis in the Prevention and Control of COVID-19 in Medical Institutions.

Background:Coronavirus disease 2019 (COVID-19) has caused massive casualties, severe economic losses, and poses a threat to the world. This study’s primary objective was to analyze the hospital’s potential hazards of COVID-19 prevention and control. The second objective was to review the disaster plan and make recommendations to minimize the spread of COVID-19 in hospitals.Methods:An expert group for the prevention and control of COVID-19 in the First People’s Hospital of Long-quanyi Dis-trict, Chengdu, China was established. We adopted the hazard vulnerability analysis (HVA) to risk-stratify potential hazards and calculated relative risk values. We used the Delphi expert consultation method to propose and implement targeted improvement measures for the top five potential hazards. Then, the effects before and after the intervention were compared.Results:The top five hazards were: insufficient Personal Protective Equipment (PPE) (25.68%), inadequate diagnosis ability of clinicians (22.55%), and inadequate management strategies of patients and caregivers (22.38%), lack of professional ability of pre-checking and triage staff (16.96%), lack of knowledge of COVID-19 of medical staff (15.59%). After taking targeted improvement measures, the average score of the hospital staff’s COVID-19 knowledge test increased from 73.26 points to 90.44 points, the average test score of the outsourcing company employees increased from 68.55 to 89.75 points. The differences were statistically significant (P<0.05).Conclusion:HVA can be used to systematically risk-stratify potential threats, measure the probability of those potential hazards, and develop various hospital prevention and control measures for COVID-19 epidemics.

Effects of simulation training on COVID-19 control ability and psychological states of nurses in a children's hospital.

This study aims to discuss the effects of simulation training on improving the pre-examination, triage, prevention, and control of coronavirus disease 2019 (COVID-19), explain the psychological states of pre-examination and triage staff in general hospitals during the COVID-19 epidemic, and analyze relevant influencing factors. This study may serve as a reference of psychological consultation services to medical staff. This study included 60 nurses assigned in the pre-examination department, fever clinics, and isolation wards of a general hospital from January 26th to February 1st, 2020. Before assuming the posts, the nurses received simulation training on the clinical reception of suspected patients with COVID-19. Operation skills of the nurses before and after the training were assessed. The percent of passing significantly increased from 65% before the training to 98.33% after training (p<0.05). Training also significantly relieved the anxiety and depression of the nurses (p<0.05). Scenario-simulation training can increase the emergency abilities of pediatric nurses in the prevention and control of the COVID-19 epidemic and relieve the anxiety of nurses.