Our assessment team analyzed operational data, reviewed governance, roles, and responsibilities, agreed baseline performance metrics, and recommended an action plan.
Improvement opportunities were identified for front-end processes, patient flow, staff communication, training on ESI 5-level triage system with inter-rater reliability, and standardization of the charge nurse role. Connecticut Children’s requested a second consultant to lead a 6-month performance improvement (PI) engagement.
Improved ED performance
Based on the assessment, the PI consultant recommended prioritizing focus on charge nurse development, direct bedding, triage/front-end process, and throughput. A charge nurse training curriculum was created with focus on patient flow, resource management, change management, and conflict intervention.
The consultants helped implement new ESI triage training and processes aligned with the American Academy of Pediatrics standards.1 Inter-rater reliability helped validate triage assessments and ED patients were triaged according to the new ESI processes.
New Vital Signs processes
The ED Staff reported that a full set of pediatric vital signs (VS) were taking too long or not completed due to patient discomfort. According to the new ESI processes, blood pressure measurement and pulse oximetry was not necessary in all patients. Once the new processes were implemented, the pediatric VS issue dissipated. Nurses retained the autonomy to obtain a BP as clinically indicated if outside the established parameters.
Vital Signs completion decreased from 18 to 15 minutes – a 17% improvement. An unanticipated outcome of the project was a reduction in missing VS documentation.