Falconer Stella S, Karuppan Corinne M, Kiehne Emily, Rama Shravan
Springfield, MO; St. Louis, MO; Iselin, NJ.
Springfield, MO; St. Louis, MO; Iselin, NJ.
J Emerg Nurs. 2018 Nov;44(6):589-597. doi: 10.1016/j.jen.2018.05.006. Epub 2018 Jun 13.
Vital signs can result in an upgrade of patients' Emergency Severity Index (ESI) levels. It is therefore preferable to obtain vital signs early in the triage process, particularly for ESI level 3 patients. Emergency departments have an opportunity to redesign triage processes to meet required protocols while enhancing the quality and experience of care.
We performed process analyses to redesign the door-to-vital signs process. We also developed spaghetti diagrams to reconfigure the patient arrival area.
The door-to-vital signs time was reduced from 43.1 minutes to 6.44 minutes. Both patients and triage staff seemed more satisfied with the new process. The patient arrival area was less congested and more welcoming.
Performing activities in parallel reduces flow time with no additional resources. Staff involvement in process planning, redesign, and control ensures engagement and early buy-in. One should anticipate how changes to one process might affect other processes.
生命体征可能会导致患者的急诊严重程度指数（ESI）级别提升。因此，最好在分诊过程早期获取生命体征，尤其是对于ESI 3级患者。急诊科有机会重新设计分诊流程，以满足所需协议，同时提高护理质量和体验。
我们进行了流程分析，以重新设计从进门到获取生命体征的流程。我们还绘制了流程程序图，以重新规划患者到达区域。
从进门到获取生命体征的时间从43.1分钟减少到了6.44分钟。患者和分诊工作人员似乎对新流程都更满意。患者到达区域不再那么拥挤，更加宜人。
并行开展活动可减少流程时间，且无需额外资源。工作人员参与流程规划、重新设计和控制可确保他们的参与度和早期认同。应该预见一个流程的变化可能会如何影响其他流程。
