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Problem: Emergency departments throughout the nation are experiencing crowding related to increased patient volumes and decreased hospital inpatient bed capacity. As a result of lengthy wait times, patients are leaving without having medical treatment, and satisfaction is poor. The purpose of this quality improvement initiative was placing a provider in triage to complement the existing split-flow process aimed to decrease wait times to see a provider, length of stay (LOS), left without being seen (LWBS) rates, and improve patient satisfaction., Methods: A multiprofessional team was established. Nurses, advanced practice providers, and physicians collaborated on a project to place a provider in triage to assist in seeing patients as soon as possible and begin care or treatment., Results: The outcomes of the initiative were positive for ED LOS metrics and patient satisfaction. Door-to-provider time decreased from a high of 56 minutes to a low of 13 minutes. The percentage of patients LWBS decreased from a high of 12% to a low of 1.62%., Discussion: The project showed that the evidence-based practice of a combined split-flow and provider-in-triage model resulted in improvements in throughput for patients who were treated and released from the emergency department., (Copyright © 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Problem: Health care professionals have not been successful in recognizing or rescuing victims of human trafficking. The purpose of this project was to implement a screening system and treatment algorithm in the emergency department to improve the identification and rescue of victims of human trafficking. The lack of recognition by health care professionals is related to inadequate education and training tools and confusion with other forms of violence such as trauma and sexual assault., Methods: A multidisciplinary team was formed to assess the evidence related to human trafficking and make recommendations for practice. After receiving education, staff completed a survey about knowledge gained from the training. An algorithm for identification and treatment of sex trafficking victims was implemented and included a 2-pronged identification approach: (1) medical red flags created by a risk-assessment tool embedded in the electronic health record and (2) a silent notification process. Outcome measures were the number of victims who were identified either by the medical red flags or by silent notification and were offered and accepted intervention., Results: Survey results indicated that 75% of participants reported that the education improved their competence level. The results demonstrated that an education and treatment algorithm may be an effective strategy to improve recognition. One patient was identified as an actual victim of human trafficking; the remaining patients reported other forms of abuse., Implications for Practice: Education and a treatment algorithm were effective strategies to improve recognition and rescue of human trafficking victims and increase identification of other forms of abuse., (Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Problem: Sepsis is a leading cause of death in the United States; however, health care providers struggle with timely recognition, diagnosis, and treatment of patients. Both the Centers for Medicare and Medicaid Services and the National Quality Forum have identified this diagnosis as a priority. Presently, many patients with sepsis are identified late, resulting in significant morbidity and death., Methods: In this project, a collaborative, interprofessional approach was created for screening and early identification of ED patients with possible sepsis. The department has 38 beds with annual patient volumes of more than 40,000 visits. Education was provided about the symptoms and treatment of patients with sepsis. A screening and management algorithm tool was instituted that consisted of early identification triggers and how to intervene according to Surviving Sepsis Campaign recommendations. The tool allowed for assessment of the patient by the ED team; the team worked to determine if sepsis was present and the extent of the illness., Results: During the first 4 months after implementation, more than 240 patients were screened, assessed, and treated according to the algorithm. Project outcomes resulted in an increase in staff knowledge of sepsis, a decrease in length of stay by 3 hours, and a significant decrease in mortality when compared with the previous year's coded data., Implications for Practice: This project demonstrates that sepsis education and team collaboration are an integral part of identifying and treating patients with sepsis. An interprofessional collaborative approach could be implemented in other institutions to combat the life-threatening complications of sepsis., (Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

ED volume and acuity were anticipated to increase at an inner-city hospital. A strategy to mitigate the impact was needed., Methods: A multidisciplinary team facilitated a workflow modification project implementing a Super Track to treat low-acuity patients. A literature review led to the creation of an evidence-based framework. Staff education regarding the change process and the results of an analysis in the strengths, weaknesses, opportunities, and threat format, along with simulation exercises and a pilot project, supported implementation of this strategy., Results: Simulation exercises demonstrated that the proposed workflow with a Super Track had the potential to reduce the length of stay among level 4 and 5 patients coming to the emergency department. Implementing a Super Track reduced the patient arrival-to-provider time for low-acuity patients, but length of stay was not affected. After implementation, the number of patients who left without being seen decreased by 40%, and patient satisfaction increased by 36%., Implications for Practice: A modified front-end workflow process produced a statistically significant, sustainable improvement in patient flow of low-acuity patients in our emergency department. Use of an evidence-based, multidisciplinary team approach supported the change process., (Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)