P042: Use of technology to create economically sustainable supplemented triage: a feasibility study at an urban tertiary care centre

Abstract

Introduction: Decreasing patient Length of Stay (LOS) in the Emergency Department (ED) improves patient safety. Numerous studies have taken differing approaches to supplementing care at triage in order to decrease LOS, however, have not proven to be financially sustainable. The goal of this study was to explore financially viable options to expedite care in a safe way and reduce patient LOS. Methods: The ED process chain was identified. Two reviewers observed triage for a 4-hour period following patients. Times from patient arrival to: completion of triage, completion of registration, test ordering, physician assessment and final disposition were measured. Results were presented at departmental rounds. Nursing staff, Physician Assistants, Residents and Physician staff were paired in interdisciplinary groups to brainstorm and trial approaches to expedited test ordering and use of technology to carry out orders. Results: Triage interruptions increased time to triage a patient up to 3 times baseline, and 33% of triage interactions were interrupted. A bottleneck occurred at registration, increasing time to be registered by up to 30 minutes. Also, registration is using antiquated technology, significantly increasing registration time. Average patient LOS was 249 min, but was only 120 min if there was no delay in test ordering for patients. Average time for MD disposition was 129 min, but was only 47 minutes if there was no delay in ordering tests. Brainstorming lead to the following ideas: 1) use of companion phones to access already-working ED MD for test ordering and ECG interpretation 2) the use of the computer system to flag new orders or ECG for triage patients 3) use of a dedicated iPad in zones 4) increased standing orders for RNs to order diagnostic imaging. Conclusion: Patient LOS was reduced by lack of delay in test ordering, in keeping with previous studies. Numerous points in the process chain were identified for creating an economically sustainable supplemented triage to improve patient flow. These were: interruptions to triage, registration bottleneck, technology at registration, test ordering at triage. Ways in which to effectively order tests at triage include: MD-companion phones, pre-existing computer program, dedicated iPad in zones. The next step in this study is to trial each of these low-cost technologies.