Project Title: Emergency Department Fast-track System and Triage Team
Project Start Date: Project End Date:
Project Manager: Student Name Here
Budget Information:
Measurable Project Objectives – (Use 5 W’s and H. Sipes, 2016):
- The implementation of a fast-track system with a triage team will effectively screen patients arriving to the Chamberlain Hospital (CH) Emergency Department (ED) and decrease the arrival-to-triage time from 17 minutes to 2 minutes in the next 6 months.
- Incorporating the use of the Emergency Severity Index (ESI) to appropriately categorize level of acuity for patients coming to the ED will assist with efficient triaging and patient throughput by decreasing patient waiting time that is greater than 15 minutes for a bed by 50% in the next 6 months.
- ED patients will report an increase in satisfaction rating related to their care in the ED from 5/10 to 8/10 by improving arrival-to-provider time and increase staff availability to perform regular rounding on patient in the next 6 months.
- Restructuring of the ED and developing a space for an ED fast-track triage desk away from the main ED waiting room will decrease overcrowding to reduce the rate of patients leaving without being seen (LWBS) from 4.6% to 2.3% within the next 6 months.
Approach: The development of a fast-track system with a triage team will be implemented by involving project team of key stakeholders which would include, the Project Manager, sponsor, Medical Director of CH, ED nurse manager, ED charge nurse, ED provider, House Supervisor, Chief Financial Officer (CFO), Human Resource (HR) and engineering. The initial meeting with the project team will review data of the current status of the CH ED that are leading to poor patient outcomes and patient satisfaction. Through collaboration of the project team, a defined structure of the triage team will be determined in order to improve effective screening of ED patients to enhance throughput, decrease LWBS and improve patient outcomes. Focus group meetings will be held every Thursday from 1000 AM to 1100 AM from September 1, 2022 until the projected project end date of March 1, 2023. Within these meetings, the focus group will discuss staffing needs, ED and hospital workflow, design-planning for fast-track triage area, and other ED construction such as the waiting room remodel or equipment needs to improve overall workflow of the department while ensuring that the project remains on track and is staying within the $1 million budget that has been allocated towards the project.
Roles and Responsibilities:
- Project Manager – planning, organizing and directing the completion of the project
- Project Sponsor – provide approval and funding of the project
- Medical Director of CH – additional approval for the project and provides direction as needed
- ED Nurse Manager – provide feedback for specific elements needed to support practice changes for nursing staff, collect data and projections on anticipated workload. Coordinate with supply chain management, pharmacy or other vendors to ensure necessary fixed assets are obtained. Work with ED physician and charge nurse on fast-track triage process, workflow and use of ESI.
- ED charge nurse/registered nurse – provide input on nursing workflow, workload and staff needs. Work with ED physician and nurse manager on fast-track triage process, workflow and use of ESI.
- ED provider – provide input on physician workflow, workload and staff needs. Collaborate with ED nurse manager and charge nurse on triage process, workflow and use of ESI.
- Chief Financial Officer (CFO) – to assist with financial planning and budgeting of the project
- Chief Nursing Officer – to provide support and oversee practice changes of the nursing team in the ED and ensuring high standards of care are maintained
- House Supervisor – provide feedback on overall flow of patients within CH and staffing support that may impact practice change in the ED
- Human Resource – to assist with the recruitment of additional FTEs
- Engineering – to manage the construction aspect of the project and ensuring codes and building laws are carefully followed. Coordinate with contractors to complete construction projects.
Comments (from each of the stakeholders listed in the Roles and Responsibilities):
- Project Manager – “A fast-track system and triage team is an evidenced-based process that will enhance the workflow and quality of care provided in the ED.”
- Project Sponsor – “I standby the fast-track system and believe it will provide great return on invest for Chamberlain Hospital overall.”
- Medical Director of CH – “I look forward to seeing the progress of this project and would like to see our facility veer towards the national benchmark LWBS rate of 2%”
- ED Nurse Manager – “We would like to have more than 2 maintained to FTEs with this change project.”
- ED charge nurse/registered nurse – “I agree with Sara (ED Nurse Manager), if this project is supposed to enhance throughput, that will increase workload, which means we will need a lot more nursing staff.”
- ED provider – “This is a great idea! I came from another hospital in the east coast and it was extremely efficient.”
- Chief Financial Officer (CFO) – “If this works the quick turn over on beds will increase our bottom line”
- Chief Nursing Officer – “Full team cooperation will be pivotal in getting this off the ground”
- House Supervisor – “This will bring a degree of efficiency we have been lacking and staff will have more direction”
- Human Resource – “Just let me know what you need and I’m here to help.”
- Engineering – “I think 6 months is pushing it a little, but our team will do our best.”
Appendix B: Scope Statement
Organization’s Name: Chamberlain Hospital
Project’s Name: Emergency Department Fast-track Triage Team
Project Manager: Student Name Here
Sponsor(s), Title: Sponsor Name Here (may be the student’s mentor)
Organizational Priority (High, Medium, Low): High
______________________________________________________________________
Mission Statement: To provide better care of the sick, investigation into their problems and further education of those who serve.
Measurable Project Objectives – (Use 5 W’s and H. Sipes, 2016):
- The implementation of a fast-track system with a triage team will effectively screen patients arriving to the Chamberlain Hospital (CH) Emergency Department (ED) and decrease the arrival-to-triage time from 17 minutes to 2 minutes in the next 6 months.
- Incorporating the use of the Emergency Severity Index (ESI) to appropriately categorize level of acuity for patients coming to the ED will assist with efficient triaging and patient throughput by decreasing patient waiting time that is greater than 15 minutes for a bed by 50% in the next 6 months.
- ED patients will report an increase in satisfaction rating related to their care in the ED from 5/10 to 8/10 by improving arrival-to-provider time and increase staff availability to perform regular rounding on patient in the next 6 months.
- Restructuring of the ED and developing a space for an ED fast-track triage desk away from the main ED waiting room will decrease overcrowding to reduce the rate of patient leaving without being seen (LWBS) from 4.6% to 2.3% within the next 6 months.
Justification of Project: In the CH ED in San Diego County, there has been increased issues with overcrowding in the waiting room, prolonged wait times to see an ED provider and a decline in patient satisfaction scores that has led to a notably high rise in the leave without being seen (LWBS) rate. The current LWBS rate in the ED is 4.6% which is well above the national benchmark of 2%. Patient who LWBS can have a negative impact on the healthcare organization and the community as a whole.
Implementation Strategy: The development of a fast-track system with a triage team will be implemented by involving all stakeholders which would include, the Project Manager, sponsor, Medical Director of CH, ED nurse manager, ED charge nurse, ED staff nurse, ED provider, bed-control, Chief Financial Officer (CFO), Human Resource, Engineering, and ED clerk. Through collaboration of this team of stakeholders, a defined structure of the triage team will be determined in order to improve effective screening of ED patients to enhance throughput. Staffing needs will be determined to ensure appropriate staffing for the fast-triage team as well as the rest of the ED. Strategic thought will be placed to determine a space to place the fast-track desk that provides functionality, enhanced patient flow, and decrease overcrowding of the ED waiting room.
Project Resources – Human and Technical: Utilizing input and expertise of the defined stakeholders will provide some of the human resources need to determine appropriate staffing and workload, approval and funding for increase in full-time equivalents (FTEs), and financial support for renovations and restructuring. IT services will be needed to ensure fast-track triage space is properly equipped with workspace needs such as computers, data-port access, and telephones. Engineering will assist with the renovations and restructuring is in compliance with building regulations.
Completion Date:
Measures of Success – Include all Metrics:
- Decrease in arrival-to-triage time from 17 minutes to 2 minutes.
- Decrease in patient wait times greater than 15 minutes for a bed by 50%.
- ED patient satisfaction rate score regarding their ED care visit will improve from an average of 5/10 to 8/10.
- Reduce the rate of LWBS from 4.6% to 2.3%.
Assumptions:
- Engineering will meet deadline to create space for a fast-track triage desk.
- Increase of FTEs and recruitment will be completed by the deadline.
Constraints:
- Obtaining ED staff buy-in due current staff burnout and compromised morale and motivation.
- Process of conducting construction in the ED may interrupt current workflow.
| APPROVALS | ||
| Print or Type Name | Signature | Date |
| Project Manager Approval: | Student name or actual PM if applicable | 9/11/2022 |
| Owner or Sponsor Title and Approval: | Practicum mentor name or actual project sponsor if applicable |
