Improving the wait time to triage at the emergency department

Triaging of patients at the emergency department (ED) is one of the key steps prior to initiation of doctor consult. To improve the overall wait time to consultation, we have identified the need to reduce the wait time to triage for ED patients. We seek to determine if the implementation of a series of plan, do, study, act (PDSA) cycles would improve the wait time to triage within 1 year. The interventions related to the PDSA cycles include the refining of triage criteria, ‘eyeball’ triage by senior nurses to facilitate direct bedding of patients, formation of a triage nurse clinician role, and a needs analysis of required nursing manpower. The baseline period for this study was from January 2017 to April 2017, with the results following implementation of the respective PDSA cycles sequentially tracked from May 2017 to March 2019. There was an improvement in the wait time to triage from a baseline duration of 18 min to the postimplementation period duration of 13 min, with a 25% decrease in variance from 16 to 12 min. The improvements were sustained. Strategies to further reduce wait time to triage at the ED are discussed. We also highlight the importance of adequate triage manpower, data-driven decision making and continued engagement of stakeholders in enabling positive outcomes from this quality improvement effort.

Critical Care Nursing in Hong Kong

BackgroundNursing shortage, especially in critical care unit, has become a big concern worldwide.AimThis study aimed to provide the current states of critical care nursing in Hong Kong.MethodsA literature search was conducted. Findings were narratively summarized.FindingsHong Kong faces an increasing demands in critical care service. However, the shortage of nursing manpower in ICU imposes challenges to meet such demands as well as the quality of critical care. Hospital authority has implemented various strategies such as the development of practice through Specialty Advisory Group (Critical Care) and Coordinating Committee in Intensive Care to address these issues.ConclusionEfforts from all stakeholders are needed to meet the demands and improve the quality of critical care.