Modified Triage to Rapidly Refer Patients from Emergency Department to Urgent Care

Abstract

Problem: An academic medical center Emergency Department (ED) has a problematic referral process to their Urgent Care (UC) creating disruptions in referrals, delays in patient care, and an overcrowded ED waiting room. Overcrowding and long wait times are correlated with increased mortality, nosocomial infections, and violence. In 2021, this ED’s average wait time was 61 minutes and the left without being seen rate was 18%, whereas the UC’s wait time was only four minutes. ED Nurse Practitioners (NPs), the sole decision makers for referral, only referred 12% of patients in 2021. Purpose: The purpose of this quality improvement project was to implement a NP quick triage to rapidly refer patients to the UC to decrease wait times, allow more access to care, and minimize crowding in the ED waiting room to provide proficient and safe care. Methods: Data was collected weekly over 15 weeks. The ER Measures Tool was developed and utilized to determine the percent of ED patients eligible for UC referred, time to UC provider, and length of stay (LOS). Changes were monitored through run charts. Results: Findings suggest the implementation of a NP quick triage can result in rapid, safe, and appropriate referral of patients to the UC. On average 31% of eligible patients were referred, which was higher than the pre-implementation rate of 30%. Findings also suggest NP quick triage did not affect time to provider and LOS. Factors that influenced referrals included patient complexity, availability and communication of the NP and triage nurse, experience of staff, and staffing issues. Conclusions: Findings suggest referral rates can be improved with a NP quick triage intervention, but LOS and referral rates are also influenced by complexity of patients, staffing numbers, communication, and experience of healthcare staff.