Emergency Triage Tool Nepal: Adaptation & Implementation
Enhancing Emergency Department Flow: A Standardized Triage Workflow for DHED
Table of Contents
Introduction
Optimizing patient flow within emergency departments (EDs) is a critical challenge, directly impacting patient outcomes, staff efficiency, and overall healthcare quality.The Department of Health and Human Services Emergency Department (DHED) sought to address inefficiencies in its triage process by developing a standardized workflow tailored to its unique layout and logistical realities. This article details the iterative design process, key recommendations, and the final standardized triage workflow that emerged from collaborative efforts with DHED staff.
The Need for a Standardized triage workflow
The existing triage system at DHED,while functional,presented opportunities for improvement. focus group discussions with ED staff revealed several key areas requiring attention:
Triage Officer Responsibilities: clarifying the scope and expectations of the triage officer’s role.
Inter-clinician Interaction: Establishing clear protocols and timelines for communication between triage staff and other clinical teams.
Encounter Documentation: Streamlining the process of documenting patient encounters during triage.
Patient Transport and Tracking: Improving the efficiency and visibility of patient movement within the department.
Addressing these critical tasks was paramount to enhancing the overall efficiency and effectiveness of the ED triage process.
Iterative Design of the Triage Workflow
The development of the standardized triage workflow was a collaborative and iterative process. Through multiple focus group sessions, DHED staff actively contributed to refining the workflow, ensuring it was practical, efficient, and aligned with the department’s specific needs.
Key Recommendations from Participants:
Participants strongly endorsed the concept of a standardized workflow that was specifically tailored to DHED’s unique layout and logistical realities. This approach was seen as crucial for improving operational efficiency and consistency.
In addition to the workflow itself, participants offered valuable suggestions for enhancing communication and visibility within the ED. These included the implementation of visual aids such as:
Color-Coded Bracelets: To quickly and clearly communicate a patient’s triage category to all staff members.
Centralized Tracking Board: To provide a real-time overview of patient status, location, and movement, thereby improving flow and reducing delays.
Workflow Iterations:
The design process involved several iterations, with each phase building upon the previous one. These iterations focused on addressing the most critical triage tasks identified in the initial discussions. The evolution of the workflow can be observed in Supplemental Figs. 1-5,illustrating the progressive refinement of the process.
The iterative design allowed for the incorporation of new features and improvements as the process unfolded. For instance, as the team delved deeper into the workflow, enhancements related to improving patient transport and tracking were integrated, further optimizing the patient journey through the ED.
The Final Standardized Triage Workflow
The culmination of the iterative design process was a final, comprehensive triage workflow that integrated the best elements of all participant suggestions. This workflow provides clear, step-by-step instructions for every stage of the patient’s journey through the ED, from initial triage to transport, monitoring, and communication of their status.
Key Features of the Final Workflow:
Prioritization of Urgent Cases: The system is designed to prioritize urgent and emergent cases, ensuring that patients with the most critical needs receive timely attention. Clear Role Definition: It establishes clear roles and responsibilities for the triage officer and other ED staff,minimizing confusion and maximizing efficiency.
Addressing High-Risk Patients: The workflow incorporates specific feedback and protocols for effectively managing high-risk patients, ensuring their safety and appropriate care.
Built-in Flexibility: Recognizing the dynamic nature of the ED habitat, the final version includes built-in flexibility, allowing for necessary consultations and the completion of all required documentation without compromising patient care or workflow efficiency.
The final triage workflow is visually represented in Fig.1.
Staff Confidence in the New Workflow:
Following the development of the final workflow, participants were asked to rate their confidence in the ability of DHED staff to adhere to the proposed system on a 5-point scale.The results indicated a high level of confidence among the staff, with 12% reporting they were ‘Confident’ and a significant 88% stating they were ‘Very confident.’ This strong endorsement suggests a high degree of buy-in and optimism regarding the potential of the new standardized triage workflow to improve ED operations.