Date of Graduation

Winter 12-16-2015

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Elena Capella

Second Advisor

Francine Serafin-Dickson


Left Without Being Seen (LWBS) rates have been described as “the gold standard of metrics” for high acuity units. In this project, the aim is to increase patient access to care by decreasing both wait times for patients and the LWBS rate for the unit, which approaches 6%. As part of a military hospital, the unit provides for veterans, active duty service members, and their families, with ages ranging from infant to elderly, in a 24 hour acute care hospital setting.

Triage training was identified as a necessary first-step for improving the unit efficiency and increasing patient satisfaction. While the Emergency Severity Index (ESI) 5 tier process has been in place, staffing changes have caused a knowledge gap among nurses on the unit. The adopted training program included a pre-program self-assessment and test, as well as a post-program self-assessment, test, and on-shift competency check. All physical materials for training were provided by Agency for Healthcare Research and Quality free of charge, with an online class following these materials provided by the ESI Triage Research Team, LLC.

Completion of the program showed improvements in nurse triage skills, with average test scores increasing 16.25%, and self-assessments showing improved confidence. Time spent triaging post-training showed nurses performing triage in an average of 8.13 minutes. Room to Bed times did not improve, but LWBS rates decreased approximately 2%, suggesting a culture change as the primary cause.

Future study should focus on post-triage crowding as the most likely cause of extended wait times.