BACKGROUND AND PURPOSE

Background:

◗ Kootenai Health is a 292-bed community hospital, Level II State designated Trauma Center, and a Level III American College of Surgeons (ACS), with a 26-bed Emergency Department.

◗ In 2015 the Emergency Department treated 52,000 patients.

◗ The Emergency Department educator noted that Emergency Severity Index (ESI) scores were frequently inaccurate.

Purpose:

◗ Improve the accuracy of the ESI score assigned to patients presenting to the emergency department.

◗ Educate nurses about the ESI Triage Algorithm and assigning correct ESI levels.

METHODOLOGY

◗ Baseline audit of ESI scores one week prior to the implementation of bi-weekly emails.

◗ Repeat audit one week after the month of educational emails.

◗ The audit reviewed: initial triage note, vital signs, and utilized the ESI Triage Algorithm to score each patient.

◗ 25 charts reviewed per day for a total of 175 before email intervention and 175 after email intervention.

◗ Emails were sent to all registered nurses working in the Emergency Department.

◗ Email questions were all obtained from the Agency for Healthcare Research and Quality (AHRQ) Handbook for ESI (2012,Version 4).

kh.org | 208.625.40000

7.13.2016

Carlana J. Coogle, MSN, RN, CEN | Kootenai Health, Coeur d’Alene, ID

Improving Emergency Severity Index Score with an Email: Can it be This Easy?

RESULTS

◗ The baseline audit showed that nurses incorrectly assigned the ESI score 37% of the time.

◗ Post intervention, ESI scores demonstrated an incorrect ESI assignment 15% of the time.

◗ A chi-square test was performed and the percent of incorrect scores was statistically signifi cantly lower after education (37% vs. 15%, p<0.0001).

OUTCOMES

◗ One area of notable improvement was accurately assessing patients at ESI level 2 instead of ESI level 3. Nurses were incorrectly assuming that anything less than Cardiopulmonary Resuscitation would not qualify as a lifesaving intervention.

◗ The response was so overwhelmingly positive that we are now sending out a variety of quick questions that range from trauma scenarios to drug calculations, and rhythm strips.

◗ This simple intervention can be easily adapted to any Emergency Department with a minimal cost of time and effort.

REFERENCES AND CONTACT

References upon request. Contact Carlana Coogle at ccoogle@kh.org or (208) 625-5719.

Figure 1: ESI Improvement

40

35

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25

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0% o

f In

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ES

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Pre-Email Post-Email

37%

15%

Figure 2: Sample Emails

1. An 88-year-old female is brought to the ED by EMS. This a.m. she had an episode of slurred speech and weakness of her left arm that lasted about 45 min. She has a history of a previous stroke and takes an ASA daily. She is alert and oriented with clear speech and equal hand grasps.

What is her ESI level? __________

2. “I suddenly started bleeding and passing clots the size of golf balls” reports a pale, 34-year-old who is 10 days post partum. “I never did this with my other pregnancies. Can I lie down before I pass out?” VS BP 86/40, HR 130, RR 22, Sp02 97%.

What is her ESI level? __________

Figure 3: ESI Triage Algorithm V4