Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., . . . Dellinger, R. P. (2017). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine, 43(3), 304-377. doi:10.1007/s00134-017-4683-6 Improving Emergency Room Triage : A Quality Improvement Project Saturday M. Ugbo, BSN, RN Chair: Dr. Mary Kamienski, PhD, APRN : Team Members : Mary Digiulo, DNP, APRN, FAANP ; Arlene Frederick, DNP, APRN, RN

Introduction Online lecture provided after pretest The Emergency Severity Index (ESI) is Same questions provided after training  A method of standardization of patient’s Confidence scale used to measure confidence in acuity in the United States pretest and posttest.  Five-level ED triage system and algorithm Outcome Measures: The outcome measures of this  Help identify patients who cannot wait to be project was focus on evidence of increased learning seen based on ESI level education provided to advanced  Centered around right patient to the right degree FNP-EC students and evidence of resources at the right place and the right time Methodology This project also examined three components of the compliance with the use of the ESI triage level tool. three-six hours sepsis bundle to find what interventions Increase in the ED wait times and over  This DNP project is a quality improvement The purpose of this QI initiative project is to crowdedness assessment designed to evaluate if ESI increase nurse’s confidence and knowledge  Affordable Care Act (ACA). education improves nurse’s knowledge and through ESI education.  Expansion to Medicaid and uninsured confidence level. Tools/Instrumentation.  Increased ED visit by over 140 millions  Using a standardized test survey and Two tools were used in this quality improvement patients a year confidence questionnaires. project to measure outcomes; the ESI level tool  The patients receiving Medicaid increase from  After securing Institutional Review Board developed by ESI experts of AHRQ and the NASC- Discussion/Implication 26 to 34% (IRB) approval, ESI education was provided CDM questionnaire for confidence level. Training and continuing education of ESI –  Increase triage error due to increase demand to emergency care students in DNP program. Data Analysis triage is necessary. and over crowdedness Framework Wilcoxon Signed Rank Test Translation of implementation to practice  Delay in patients treatment and revenue loss theory of experiential learning proposed by Paired T test to analyze frequency, mean and SD Additional training tool to increase nurses to hospitals David Kolb SPSS and Excel for data analysis confidence in triage is necessary EMTALA: Emergency Medical Treatment and Chat graded after completion of training Improve knowledge will lead to safer practices Labor Act 1986 Chat recorded in Qualtrics Training of nurses and knowledge testing  Medical screening to all patients regardless of before assigning to triage. insurance status Decrease rate of errors, by ongoing ESI Social Determinants of Health education.  Lack of preventive care Project Design: This project utilized a quality Areas of further studies in triage on how to  Poverty, and other social factors improvement design to evaluate change in improve nurses confidence.  ED as a safety net for the entire population practice. including the uninsured.  This QI project is based on the presumption References Background and Significance that knowledge of ESI level will improve  Farzad Rahmani, Pegah Sepehri Majd, Haniyeh nurses triage level. Ebrahimi Bakhtavar, & Farnaz Rahmani. (2018). Evaluating the accuracy of emergency nurses in  One in five Americans visit the Emergency Setting :This QI project will take take in one of the correct triage using emergency severity index triage Department at least once per year. largest urban institute of higher learning located in Sina hospital of Tabriz: a cross-sectional  The visits ranges from urgent to non-urgent. in norther New Jersey. analysis. Journal of Emergency Practice and Factors like EMTALA, ACA other social Study Population: Participants for this QI Trauma, 4(1). determinants of health has increased the project is primarily the students enrolled in an  Grossmann, F. F., Zumbrunn, T., Ciprian, S., Stephan, numbers of patients visiting the ED. advanced degree program in Family Nurse F. P., Woy, N., Bingisser, R., & Nickel, C. H. (2014). Results/ Anticipated Results  As a result of the upsurge, the ED continues to Practitioner emergency care (FNP-EC). Undertriage in older emergency department Statistically significant difference with a P-value face a problem of over crowdedness and thus  These students are also work as emergency patients–tilting against windmills?. PloS one, 9(8), of 0.002P<0.05 e106203. must adopt an efficient method to sort and department Nurses in their various place of Null hypothesis rejected.  Jordi, K., Grossmann, F., Gaddis, G. M., Cignacco, E., treats patients in order of severity. employment. Results shows increase in ESI education will Denhaerynck, K., Schwendimann, R., & Nickel, C. H.  The ESI is a unique triage tool that helps to  The demographics information about these increase ESI accuracy. (2015). Nurses’ accuracy and self-perceived ability mitigate against the unwanted delays in the students are not part of this project. A using the Emergency Severity Index triage tool: a No significance changes in Confidence level. ED and helps connect patients to resources, convenience sample of the students were cross-sectional study in four Swiss places and time. utilized for this study. hospitals. Scandinavian journal of trauma,  Improving ESI is important in providing Study Interventions: This quality improvement resuscitation and emergency medicine, 23(1), 62. patient’s safety and outcome project provided two interventions for the  Kolb, D. (1984). David Kolb's learning styles model and experiential learning theory (ELT). Retrieved on student. April 26, 2013 from Contact Information 11 DNP/ED nurses randomly participated. http://www.businessballs.com/kolblearningstyles.ht [email protected] Participants were anonymous m 20 standardized case base scenario on ESI