New emergency department technology cutting triage time in half


Lisa Paul was scared.

A new electronic triage application at The Scarborough Hospital (TSH) is cutting triage time in half and giving its multicultural patient population the opportunity for more control over their reassessment while in the waiting room. TSH is the first hospital in Ontario and the second in Canada to launch eTriage software, part one of a two-pronged multilingual approach to emergency triage and reassessment. The “Enhancing Emergency Services” project combines an electronic application at the start of the triage process, with ongoing patient-driven reassessment using kiosks located in the waiting room.

“E-triage is definitely the standard to push and to move forward,” says Louise LeBlanc, Patient Care Director, emergency services at TSH. “We have been electronically tracking our patients since 1998, so this is the next logical step.” Patients presenting to TSH’s General and Grace emergency departments are evaluated by a triage nurse, who enters symptoms and other data into a computer. The computer analyzes the data, and determines the acuity level of the patient based on the one-to-five Canadian Triage Acuity Scale (CTAS). “The acuity will show up based on the information the triage nurse feeds into the computer,” LeBlanc adds. “And the nurse can over-ride the system based on their observations and experience. But they can only triage to a more acute level.”

It’s been less than a year since eTriage began as a pilot project at TSH, and the system is already proving beneficial to both patients and frontline staff. “E-triage helps to process patients in an effective, timely manner, which is accurate in accordance with CTAS standards,” says triage nurse Steve Gillis, who accepted a six-month secondment as clinical lead on the project in November 2007. “It keeps all triage nurses on the same page in terms of what level patients are being triaged at. At the same time, it allows nurses to exercise their clinical judgement and to override the system to a more acute level if necessary.”

The second part of the project, known as Enhancing Emergency Services (EES), involves the implementation of multilingual patient-driven kiosks. Integration of the kiosks into department workflow is underway and is being followed closely by project partners Medisolve, University Health Network and Canada Health Infoway. The kiosks (there are five at the General and three at the Grace) are still new arrivals within the ED waiting rooms and are expected to show their full potential in the coming months. They show great promise, especially for the multicultural population that TSH serves.

While all ED patients report to the triage nurse on arrival, the triage nurse may direct selected stable patients to a kiosk to begin the registration process with a swipe of their health card. Once the triage assessment is completed by the triage nurse, the triage nurse can direct the non-acute patient to scan their wristband at a kiosk should their condition change or at pre-selected intervals to update their condition. Patients are asked specific questions in one of nine languages selected (English, French, Cantonese, Mandarin, Tamil, Punjabi, Farsi, Hindi and Urdu). If a patient’s responses to the questions indicate their condition has worsened while in the waiting room, the triage nurse is immediately alerted.

“The use of the kiosk to promote reassessments must be carefully incorporated into triage workflow,” Gillis admits. “As with all change, some nurses will be quicker to embrace the technology than others, and patient safety and department workflow will continue to be the top priorities. The kiosks are expected to prove most useful when triage nurses are very busy. Patients can then assist with their initial reception and, later, update their condition and receive important instructions electronically. The nurse will ultimately be better informed and the waiting room will be a safer place.”

Considered an adjunct to the role of triage nurses, e-triage is designed to promote, not interrupt, patient flow. “The initial data we have received shows e-triage has cut our triage time in half, so we’re saving a lot of time and we’re more accurate,” explains Kiki Ferrari, Patient Care Manager, emergency & urgent care. “Having the right triage score means we are putting the patient in the right part of the emergency department with the right caregiver at the right time.”