In many large hospitals, the emergency department faces significant challenges related to patient triage, resulting in lengthy wait times and potential misallocation of resources.
A central triage team responsible for assessing a diverse array of patients often encounters difficulties due to the complex and nuanced presentations of those seeking care. This complexity can lead to over-triage, where patients are unnecessarily placed in high-acuity settings, and under-triage, where critical cases might not receive the immediate attention required.
Such discrepancies not only strain hospital resources but also potentially worsen patient outcomes. Patients may be admitted and then quickly discharged, indicating an initial misjudgment of their required level of care (nothing frustrates a resident more than having to write an admission note and a discharge note within the same shift). Similarly, the variability in patient management—where some with multiple symptoms might need simple care, and others with minimal symptoms require intensive treatment—further complicates the triage process.
Swimlane Diagram
A swimlane diagram is a type of flowchart that visually distinguishes job-sharing and responsibilities for different sub-processes within a business process by arranging the process steps into lanes. The star indicated a bottleneck or key inefficiency in the process.
Insights
Root Cause Analysis: 5 Whys
The 5 Whys process in root cause analysis involves repeatedly asking "Why?" five times to drill down into the root cause of a problem by exploring the cause-and-effect relationships underlying the issue.
The problem: Inefficient patient triage in large hospital EDs leads to lengthy wait times, misallocation of resources, and inappropriate levels of care.
Why?: the presentations of patients are complex and nuanced, making quick and accurate assessments challenging.
Why?: the triage team may not have sufficient specialized training or access to enough information at the point of triage to make accurate decisions.
Why?: the existing triage protocols and training programs may not be comprehensive enough to cover the wide variety of cases encountered, and there might be a lack of real-time support tools like decision aids or AI systems.
Why?: there may be a lag in updating protocols to reflect the latest medical guidelines or technological advancements.
Why (root cause)?: hospital budgets are often constrained, with funding priorities set on immediate clinical needs and responses to regulatory demands rather than on systemic improvements like training or technology upgrades.
Impact Analysis
Impact analysis is the assessment of the potential consequences and effects that changes in one part of a system may have on other parts of the system or the whole.
Patient: for patients, these inefficiencies can lead to longer wait times, which not only increase discomfort and anxiety but can also worsen medical conditions, potentially resulting in poorer health outcomes.
Clinician or Provider: physicians face increased stress and burnout as they struggle to provide timely and accurate care amidst the chaos of a backed-up triage system. This can lead to decreased job satisfaction and reduced quality of care. I’ve experienced this firsthand. As I stated above, having to do an admission and discharge on someone within the same shift is frustrating and not an optimal use of time when the patient could have otherwise been discharged from the ED.
System: inefficient triage processes contribute to resource misallocation, where critical resources like beds and medical staff are not optimally used. This mismanagement can increase healthcare costs and decrease the overall efficiency of hospital operations, ultimately impacting the quality of healthcare services provided to the community.
Potential Solutions
Implementation of AI-Assisted Triage Systems: Deploy artificial intelligence systems that can predict the likely length of stay and necessary level of care based on initial presenting symptoms, laboratory results, and vital signs. This technology would help triage teams make more informed decisions quickly, improving patient flow and resource allocation. You can train a model on millions of data points with inputs listed above and outcomes like LOS. The company I wrote a sponsored deep dive about, Pieces Technology, could likely do this.
Enhanced Triage Protocols and Staff Training: Revamp existing triage protocols to incorporate more detailed and nuanced guidelines that cater to the variety of cases typically seen in emergency departments. Additionally, invest in ongoing staff training programs to ensure triage teams are well-equipped to assess and assign appropriate levels of care efficiently.
Development of Multi-Disciplinary Triage Teams: Establish triage teams that include a variety of specialists, such as nurses, physicians, and support staff, who can bring diverse expertise to the triage process. This approach would help in accurately assessing complex cases and reducing the likelihood of mis-triage, ensuring patients receive the appropriate care from the outset. I’m in favor of this approach, but it may require more resources.