Bypass Rapid Assessment Triage: How Culture Change Improved One Emergency Department’s Safety, Throughput and Patient Satisfaction

ProblemEmergency department waiting rooms are high risk, high liability areas for hospitals. Patients who are greeted by non-clinical personnel or who are not being placed in available beds increases wait times and prevent patients from receiving timely treatment and access to care.MethodsA multidisciplinary team was convened to review best practice literature and develop and implement an immediate bedding process. The process included placing a greeter nurse in the waiting room who performs a quick patient assessment to determine acuity. Based on that acuity, the greeter nurse then places the patient in the appropriate available bed.ResultsWe established our Bypass Rapid Assessment Triage process and improved door-to–triage, door-to-bed, and door-to-physician times while enhancing patient satisfaction.Implications for practiceA system should be in place that allows for immediate bedding wherever possible. Transitioning to immediate bedding requires a culture change. Staff engagement is essential to achieving such a culture shift.