Improving the Flow: Optimization of Available Triage Standing Medication Orders in the Pediatric Emergency Department.

BACKGROUND: Emergency department (ED) overcrowding has led to longer waits for patients to be seen, treated, and released. This has been coupled with an increased number of patients who leave without ever being seen by an ED provider. Improving patient throughput and decreasing ED patient length of stay while continuing to provide high-quality care is of paramount importance. Optimization of available standing orders for fever, pain, and/or nausea and vomiting at the time of nurse triage may offer an opportunity to improve patient outcomes, decrease time to medication (TTM) administration for ill and injured patients, and decrease length of stay.

PATIENTS AND METHODS: This was a retrospective cohort patient analysis for patients younger than 18 years of age presenting to the ED before (February 2019) and after (February 2020) an intensive campaign aimed at educating the triage nurses regarding the use of ED standing orders for acetaminophen, ibuprofen, and ondansetron. The investigators sought to evaluate percentage change in nurse triage-initiated (NTI) orders between the 2 time frames. Secondary outcomes evaluated TTM, documented adverse effects, percentage of inappropriate medication administrations, and correlate TTMs to ED discharge.

RESULTS: The percentage of patients who received an NTI medication was 49% in 2019 and 58% in 2020 (P = 0.257). For NTI orders, TTM initiation decreased in the postintervention group from an average of 45 minutes down to 37.6 minutes. In the overall cohort, TTM administration in the NTI group was a mean of 41.2 minutes compared with 75.9 minutes in the provider-initiated group (P < 0.0001). Length of stay was the same for the NTI versus the provider-initiated group in overall cohort (134.4 vs 142.9, P = 0.4303). No adverse events were identified.

CONCLUSIONS: Nurse-initiated medication administration at the time of triage offers an opportunity to get patients vital treatment more quickly. Medications administrated earlier in the pediatric ED encounter have a correlation to improved throughput and higher possibility of quicker discharge from the ED. Further research is needed to fully assess the impact of continuing education on improving utilization of triage standing orders and the impact on ED throughput.