OUTCOMES OF IMPLEMENTING RAPID TRIAGE IN THE PEDIATRIC EMERGENCY DEPARTMENT Authors: Stacy L. Doyle, MBA, RN, Jennifer Kingsnorth, MSN, RN, Cathie E. Guzzetta, PhD, RN, AHN-BC, FAAN, Sara A. Jahnke, PhD, Johanna C. McKenna, MSN, RN, CPN, CPEN, and Kathleen Brown, MD, Kansas City, MO, and Washington, DC Introduction: Efficiency and effectiveness are often used as quality indicators in emergency departments. With an aim to improve patient throughput and departmental efficiency while decreasing left-without-being-seen (LWBS) rates, this two-group, pre-intervention, post-intervention study in a pediatric emergency department evaluated the outcomes of implementing rapid triage on arrival-to-triage time, fast track utilization, and LWBS. Methods: We implemented rapid triage assessment integrating the Emergency Severity Index and fast track guidelines in our pediatric emergency department. Arrival-to-triage times were tracked for 1 month before and after the intervention (N = 13,910 patient visits) by recording the time the patient arrived in the department and time triage assessment was complete. Fast track utilization and LWBS rates were measured for all patients sequentially included in pre-intervention (n = 60,373) and post-intervention (n = 67,939) groups for 10 months. Results: After the intervention, patients experienced a significant decrease in arrival-to-triage times compared with the pre-intervention group (P < .001), with most patients (88.3%) being triaged in less than 10 minutes after the intervention. Following implementation of fast track guidelines, patients were 14% more likely to be triaged to fast track compared with pre-intervention patients (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.11-1.67). Additionally, patients with the lowest acuity were nearly 50% more likely to be triaged to fast track compared with pre-intervention patients (OR = 1.48, 95% CI = 1.35-1.63). Although LWBS rates were insignificant, overall acuity level of this group was lower in the post-intervention group. Discussion: Although LWBS rates did not decrease with the intervention, implementation of a rapid triage system and fast track guidelines reduced arrival-to-triage times and decreased acuity in the LWBS population. Implementing rapid triage and fast track guidelines can affect nurse-sensitive patient outcomes related to safety and care delivery in a pediatric emergency department. Key words: Fast track; Triage; Rapid triage; Pediatric ED; ESI E fficiency and effectiveness are quality indicators for every emergency department. Recognizing the need to decrease length of stay (LOS) in pediatric emer- gency departments, the Children’s Hospital Corporation of America Emergency Department group set a national goal to decrease LOS in pediatric emergency departments by 25%. Emergency department LOS can be segmented many ways (eg, arrival to triage, arrival to provider, and arrival to discharge). Each of these segments requires emergency departments to assess process effectiveness and implement process and/or system changes to expedite care delivery. Our study explored ways in which nurses could signifi- cantly affect nurse-sensitive patient outcomes such as care delivery and LOS. Stacy L. Doyle, Member, Kansas City Chapter, is Director of Emergency and Urgent Care Services, Children’s Mercy Hospital and Clinics, Kansas City, MO, and was formerly Interim Director, Emergency Medicine and Trauma Center, Children’s National Medical Center, Washington, DC. Jennifer Kingsnorth is Program Manager Trauma and Burn Services, Emergency Medicine and Trauma Center, Children’ s National Medical Center, Washington, DC. Cathie E. Guzzetta is Associate Clinical Professor of Nursing Education, School of Medicine and Health Sciences, George Washington University, and Nursing Research Consultant, Children’s National Medical Center, Washington, DC. Sara A. Jahnke is Principle Investigator, National Development and Research Institutes, Kansas City, MO. Johanna C. McKenna is Registered Nurse III, Emergency Medicine and Trauma Center, Children’s National Medical Center, Washington, DC. Kathleen Brown is Medical Unit Director, Emergency Medicine and Trauma Center, Children’s National Medical Center, Washington, DC. Funded in part by Children’s National Medical Center, Division of Nursing, Washington, DC. For correspondence, write: Stacy L. Doyle, MBA, RN, Emergency Depart- ment, Children’s Mercy Hospital, 2401 Gilham Rd, Kansas City, MO 64108; E-mail: sdoyle@cmh.edu. J Emerg Nurs 2012;38:30-35. Available online 22 January 2011. 0099-1767/$36.00 Copyright © 2012 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. doi: 10.1016/j.jen.2010.08.013 RESEARCH 30 JOURNAL OF EMERGENCY NURSING VOLUME 38 • ISSUE 1 January 2012