Implementation of the Emergency Severity Index Tool in a Community Hospital Emergency Department: An EBP Project to Improve Clinical Practice and Standardize Triage Procedures

Introduction: Emergency departments (EDs) rely on experienced nurses who act as first responders to patients and prioritize their level of acuity. These nurses "triage" or sort the patients, allocating precedence for the provision of care. Consistent triage methods are necessary to provide prompt identification of sick patients and to improve quality outcome measures. This evaluation project assessed the effectiveness of the implementation of the Emergency Severity Tool (ESI), a standardized triage tool, in enabling triage nurses to promptly identify sick patients in a consistent method and improve quality outcomes for ED patients.;Methods: Two methods were utilized to assess the effectiveness of the triage tool: a chart audit of key ED metric data that serve as benchmark information that lead to quality ED outcomes and an inter-rater percent agreement to assess the accuracy of triage decisions compared to being the intervention. Chart audits of ED data were compiled over a 12 month period, beginning 6 months before and after the implementation of the triage tool. Inter-rater percent agreement was assessed by comparing 7 nurses' triage decision making from before and after the implementation. This was assessed against an expert triage rater.;Results: Data demonstrated that the overall patient experience in the ED improved following the implementation of the triage tool, with an increase of 25% of accuracy in triage decision making. Analysis indicated increased correlation of accuracy of triage decisions, with a post intervention positive correlation of Spearman's rho =.791, p < .001 versus pre intervention Spearman's rho = .676, p< .001.Additionally, accuracy was measured by Cohen's kappa coefficient, with a pre intervention score of .244, p= - .019 versus a post intervention score of .604, p<.001 indicating marked improvement in agreement and accuracy of triages. Patient satisfaction increased, and overall wait times and ED length of stay decreased following the implementation of the tool. The greatest improvement was in triage times, which were an average 3.8 minutes per patient pre intervention and an average of 1.8 minutes per patients post intervention.;Conclusion: Implementation of this project indicated that use of the ESI tool was linked to consistency in triage and improved patient experience. Triage accuracy was improved, but despite the intervention, no triage RN had 100% accuracy following the intervention. Additional research is necessary to see how to improve the sustainability of the intervention. While overall ED numbers tended to improve, there was still disparity among triage RN decision making, indicating an issue of consistency.