Designing and managing workflow is integral to successful managing healthcare business operations. Technology such as clinical decision support mechanisms can be used to manage the workflow process (Husser, et al, 2011). Many individuals use the emergency department as the primary place of care necessitating the use of technology to manage this patient flow activity (Horsky, 2006). This paper will outline a workflow diagram for triaging patient in an emergency department.
Workflow Diagram of the Process for Emergency Department Triage
Stakeholders (Who does this help?)
There are a variety of stakeholders that manage the emergency department triage process. As noted in the diagram, the process begins by registering with the clinical secretary or registrar of the department. These individuals collect information about the patient that is used to begin the process of putting the patient in the que to be triaged. After this process is complete, the next step is to do a preliminary triage assessment, this is usually conducted by a licensed practical nurse or certified nursing assistant. This individual determines how patients should be seen, usually based on the acuity of their individual situation. Further, the person assists in making sure each patient is properly registered and ordered based on their condition. The next step in the diagram indicates that the patient will be evaluated by a nurse or doctor who will determine the next steps for the patient. Following this evaluation, the patient will receive directions about one of four courses of action. These include being discharged with a referral, being admitted, transferred, or scheduled for an outpatient appointment.
There are several uses of technologies during this process. The electronic medical record is used to collect information about the patient. And, the individual registering patients uses computer technology. Furthermore, clinicians may use clinical decision support to evaluate the patient. Technology would be used to order any medications or referrals as well. The patient may also use the patient portal to access their information for future medical appointments.
Policies and Rules
There are a number of policies and procedures related to the emergency department triage process. Following the diagram, one of the first items to note is that all interactions should comply with privacy and HIPAA guidelines. Patients should be able to communicate their information in a private secure environment. Further, staff should be trained to protect this privacy and adhere to this policy. There are also policies triage order, transfer, discharge and what information should be provided to the patient. If the patient is admitted, a gamut of additional policies kick in.
Metric used for Workflow Evaluation
There are several metrics that are tracked to manage the emergency department triage process. Throughput time is one metric that is measured. This gives one an idea about how long it takes for an individual to get through the triage process. Other metrics include time at each stage of the process and patient satisfaction with the engagement. If one part of the process is lengthier than it should be, adjustments should be made. Furthermore, the performance can be benchmarked against other facilities of similar size to measure performance.
Areas for Improvement
There are several areas for improvement in this process. Using two possible points of contact at the beginning can create confusion. Additionally, conducting two evaluations may not need to occur for all patients. Sometimes the triage process at the beginning is not needed. Furthermore, the chart does not apply time parameters to the activities which can be done to aid in staffing expectations.
Charting information about patient throughput activity can help ensure improvements are made. Being aware of how long it takes to participate in certain actions and understanding the time associated with these actions can inform many decision making activities within an organization. Diagrams can foster improvement to areas of both operation and functioning. This can make sure that patients have the best experience possible when engaging with the healthcare delivery system.
Horsky, J., Gutnik, L., & Patel, V. L. (2006). Technology for Emergency Care: Cognitive and Workflow Considerations. AMIA Annual Symposium Proceedings, 2006, 344–348.
Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Med Res Methodol, 11(1), 43. doi:10.1186/1471-2288-11-43