New mini-triage’ system cuts wait time to 15 minutes

The EDs at St. Charles Mercy in Oregon, OH, and St. Anne Mercy in Toledo have adopted a streamlined triage system to shorten waiting times, and managers report that it has been very effective without compromising patient safety.

The EDs previously employed a long, thorough triage process because patients might have had to wait for hours before seeing a physician, explains Kenneth Chelucci, MD, FACEP, medical director of emergency services at St. Anne.

The average waiting time was about 40 minutes, which meant some waited much longer. Now that waiting times are down to an average of 15 minutes, the clinicians feel comfortable with a shorter triage process. Triage now takes about three minutes, compared to about 10 minutes before. The triage nurse no longer collects a full medical history, medication list and complex description of the complaint.

"We do a mini-triage where we basically just get vital statistics and a chief complaint," he says. "Before we were getting a history of the complaint, doing a cursory nursing examination, and getting vital signs. That doesn’t sound like much, but sometimes, depending on the patient, it could take 15 or 20 minutes."

The more elaborate triage now is done jointly by the physician and nurse at the bedside. Chelucci points out that expedites physician involvement in the case, and it avoids the patient having to provide the same information twice, which they appreciate.

Though switching to the mini-triage raised some questions about patient safety, he says the ED’s experience has proved otherwise.

"In reality, we think we’ve reduced the risk because we’re getting the physician involved faster," Chelucci says.

"When someone comes in with hypertensive encephalopathy, they’re not delayed in the waiting area, and the physician lays hands [on them] almost immediately and can expedite treatment. Anything that gets the physician involved faster is going to be better for the patient," he adds.