Date of Graduation

Summer 8-9-2017

Document Access

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Mary Seed


Emergency departments pose a challenge to healthcare reform due to many factors including overcrowding, increased wait times, and lack of access. This makes it difficult to triage efficiently and to provide cost effective care. When patients leave the emergency department (ED) without being seen by a physician, the ED delivery system has failed to provide access and timely care. The left-without-being-seen (LWBS) rate is a patient-centered outcome measure that reflects quality, efficiency, and effectiveness. A yearlong practice improvement project led by a clinical nurse leader was implemented in a local safety-net teaching hospital in its twenty-six bed, Level II ED. The community encompasses diverse; multicultural; low-income; uninsured; vulnerable; and underserved residents. The project aim is to reduce the longstanding LWBS rate which is, on average, 3.5 times higher than national standard of 2%. The primary evidence-based intervention revolves around introducing a pivot triage nurse into the triage process to reduce the LWBS rate from 7% to 5% by December 31, 2017. Methods included formation of an ED triage redesign team, literature reviews, informational interviews, and chart audits to analyze flow patterns. Three change management conceptual frameworks guided the project. The LWBS outcomes were monitored through an internal dashboard and tracked against Medicare’s Hospital Compare website to measure progress. The interim evaluation results indicate a gradual decrease in the LWBS rate after the implementation of the pivot nurse. Furthermore, a newly constructed and licensed ED should contribute to the process redesign and ongoing rate reduction generating improved patient throughput and satisfaction and increased reimbursement from federal payors.

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