Emergency Care Triage

In a nutshell: The Improvement Academy is working with Emergency Medicine Clinicians across the region to improve patient care and flow in Emergency Departments by investigating the use of senior doctors in triage.

The Challenge

Emergency departments (EDs) are coming under increasing pressure from different sources:

  • Patients – The Kings fund reported that ED attendances reached 14.2 million in 2013-2014, a 12% increase from 2003-2004[i][ii].
  • Targets – Although the 4-hour wait target was relaxed from 98% to 95%, departments struggle to meet this. Patients waiting beyond 4 hours reached its highest level of 9% in the final quarter of 2013/2014[ii].
  • Beds – Emergency admissions have increased by 47% over the past 15 years[iii].
  • Staffing - The College of Emergency Medicine reported a less than 50% fill rate into higher training into the speciality in 2011-2012[iv]

Patients attending EDs usually undergo an initial triage assessment by nursing staff. A system where Senior Doctors assess patients in triage is proposed to allow a quicker, focused initial assessment, rapid initiation of appropriate treatment and avoidance of unnecessary admissions.

What are we doing about it?

The Improvement Academy is working in collaboration with Emergency Department Clinicians Professor Suzanne Mason (Sheffield Teaching Hospitals NHS Foundation Trust), Dr Kevin Reynard (Leeds Teaching Hospitals NHS Trust) and Dr Jason Lee (York Teaching Hospitals NHS Foundation Trust) on an improvement project focusing on Senior Doctor Triage with the following objectives:

  • Understand the practicalities and effectiveness of senior doctor triage in EDs
  • Undertake a regional survey of current triage processes in EDs
  • Work collaboratively with up to 5 EDs, making a more comprehensive assessment of triage services and development of triage improvement goals
  • Generate recommendations for best practice across the region

Our Future Plans

  • Visit EDs across Yorkshire and the Humber to observe different triage systems and understand where EDs are already using senior doctors in triage
  • Organise a roundtable discussion amongst ED Clinicians discussing regional practice in triage and the way forward
  • Support the planning, implementation and evaluation of improvement in triage services driven by ED teams involved in the collaborative

Improvement Fellows

Meet some of the Improvement Fellows who are contributing to improving quality and safety of healthcare services in Yorkshire and Humber.