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Sick Not Sick

Overlake Medical Center and Clinics (Bellevue, Washington)

CSI Summary

Available only to registered AACN.org users.

CSI Presentation

Available only to registered AACN.org users.

CSI Toolkit

Available only to users with a paid AACN membership.

Added to Collection

Project Topic

Patient experience in the Emergency Department

Hospital Unit

Emergency Department

CSI Participants

Arnold Andres, BSN, RN
Paula Leach, BS, BSN, RN
Madeleine Williams, BS, BSN, RN

Project Goals/Objectives

  1. To decrease the number of patients who leave without being seen (LWBS) 28% from October 2019 to January 2020
  2. To improve comfortability, understanding and application of proper Emergency Severity Index (ESI) levels
  3. To standardize RN knowledge and practice through up-to-date education

Project Outcomes

  1. Increased overall LWBS 28% but decreased 12% in peak months from previous year
  2. Increased RNs ESI comfortability 17%, understanding 8% and proper application 23%

Project Overview

Overlake Medical Center and Clinics experienced 5.5% population growth from 2013 to 2016 and has continued to steadily grow. The Emergency Department average daily census increased 6.5% from 2019 to 2020 year-to-date. Our CSI team discovered inconsistent triage knowledge among the nurses, out-of-date triage education material and a historical increase in the number of patients who left without being seen (LWBS) during our peak months of October through January.

After updating triage education, providing in-person training, creating reliable resources and revising several triage policies, we have seen a huge increase in consistency among triaging nurses. Staff reported increased comfort with, and understanding and application of the Emergency Severity Index (ESI) levels. We also saw a 12% decrease in annual LWBS rates. The goal is to present an in-person triage class and/or refresher course annually for all staff, new or old.

Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.