Providing a Nurse Practitioner in Triage

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Updated: Aug 19, 2022
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Chamberlain Hospital has been experiencing high volumes of surges leading to a higher than the national benchmark of left without being seen (LWBS) rates. The surge has led to lengthy wait times to see a provider as well as declining patient satisfaction scores. The ED accounts for nearly all inpatient admissions and 35% of the hospital’s surgical procedures. The average collection on each admission is $13,497.00 with an estimated loss of 372 patients left without being seen. This equates to an approximate loss of $5,021,130.00. By reducing the LWBS, Chamberlain Hospital will see up to $3,578,489.00 in revenue. The purpose of this paper is to discuss the project’s scope, charter, and reveal implementation strategies that will be used in the project.

Project Scope

The scope of this project will be completed through Chamberlain Hospital’s mission “To provide better care of the sick, investigation in their problems, and further education of those who serve.” In order to carry out the mission of the organization through this project a PICOT question will be developed to address patients that left without being seen in Chamberlain Hospital’s Emergency Department. The PICOT question will specifically address the LWBS quality metric of Chamberlain Emergency Department with an underlying focus of the emergency department’s culture. The PICOT question to address this issue will be “In adults ages 18-100 years of age admitted into the emergency department, does an assigned triage Nurse Practitioner decrease instances of left without being seen compared to an assigned medic in an 8 week study?”

Using the 5W’s and H., the project will be implemented using the 5 stages Project Management. The project’s aim will be apply LWBS implementations in order to decrease LWBS by 2.6% or to reach 2.0% LWBS as the national benchmark. In order to improve LWBS, an improvement in patient flow within the ED must be improved. An improvement in patient flow through triage is ultimately achieved by decreasing the amount of time patients spend in the ED. (Richard & Jarvis, 2016) To directly address patient flow, a Nurse Practitioner will be assigned to the triage area instead of a medic in order to decrease patient wait time and increase patient flow from triage to the exam rooms. 2.0 FTE’s will be allocated to this position to address surge times. Rapid assessments, labs, imaging, and other tests can all be completed after the rapid assessment of a patient in triage. This intervention will aim to maximize caregiver workflow equating to a faster and more efficient arrival to triage time, arrival to provider, and arrival to bed time. By applying a provider in triage, the provider can discharge directly from Triage and/or the waiting room in times of surge. (Knowles, Beltran, & Grover, 2020)

Project Charter

Providing a Nurse Practitioner in Triage will aim to decrease wait times, left without being seen, length of stay, admit length of stay, and overall length of stay. Implementation of nurse-initiated protocols can help initiate early diagnostic testing and improve patient throughput throughout the ED. (Settelmeyer, 2018) The overall goal of the project is to decrease Left Without Being Seen by 2.6%, aiming to reach the national benchmark of a 2% rate of Left Without Being Seen. The project will start on May 4th, 2020 and end on June 22nd, 2020 at Chamberlain Hospital’s Emergency Department. As discussed in the scope of the project, the approach to this project will be to allocate a Nurse Practitioner to the triage area of the emergency department in order to rapidly assess, diagnose, and treat patients. LWBS issues will be reported by the charge nurse using vertical communication with the Nurse Manager of the unit. The Nurse Manager will report all barriers to the project to the Project Manager. Weekly meetings will take place with the LWBS taskforce consisting of the ED Charge Nurse, Nurse Manager, Project Manager, and Director of Quality. LWBS data will be discussed during the agenda of the meetings in order to identify trends and create a risk management/ plan of action strategy if the project is not producing the expected results.


In conclusion, Chamberlain Hospital’s Emergency Department has several issues that are impacting core ED metrics. Due to surges and high volume of ED admissions, Chamberlain Hospital’s LWBS rate is 4.6%, 2.6% higher than the national average of 2.0%. The goal of this project is to improve Chamberlain Hospital’s LWBS to the national benchmark of 2.0%. In order to reach this goal, interventions to maximize caregiver workflow and improvements to patient flow through the emergency department will be made. Cultural issues will be addressed in a case by case basis including delaying of discharges and cases of incivility displayed in the scenario. A Nurse Manager’s enthusiasm to this project is key to its success. Buy-in from the staff is crucial to all stages of the project and is greatly dependent on the culture of the unit. (Herrera, 2016) Through the use transformational leadership, facilitating a positive work environment, and allocating 2.0 FTE’s to a triage Nurse Practitioner role, the project will aim to yield better quality care by the reflection of a decreased LWBS rate.


Knowles, K., Beltran, G., & Grover, L. (2020, May). Emergency department operations I: Emergency medical services and patient arrival. Emergency Medicine Clinics of North America, 38(2), 311-321.
Richard, P., & Jarvis, E. (2016, June 30). Improving emergency department patient flow. Clinical and Experimental Emergency Medicine, 3(2), 63-68.
Settelmeyer, D. (2018, May). Evaluation of an evidenced-based throat-pain protocol to reduce left-without-being-seen, length of stay, and antibiotic prescribing. Journal of Emergency Nursing, 44(3), 236-241.

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