Background: Emergency department (ED) crowding has been recognized as a growing problem. From 1995-2005, the annual number of ED visits in the United States increased nearly 20%, from 96.5 million to 115.3 million. Timeliness of care has to been shown to have a strong correlation with improved patient outcomes and increased patient satisfaction. Research indicates negative consequences of ED crowding. Attempts have been made to streamline and standardize the “front end” operations of emergency departments. Foreground: An ED located in Southern Idaho, currently assigns one nurse to the triage area. Because the assigned nurse often leaves the triage area to perform other duties, the waiting room is frequently left unattended by a healthcare provider. Administrative clerks are available but have no training in the skill of patients triage. In order to improve waiting room safety and optimize the triage process, the use of a GRASP-RN nurse was implemented in the triage area to improve door to triange time, door to room time, and triage to physician time. EBP Framework: The Revised Rosswurm and Larrabee model provided the framework for the evidence-based practice to optimize waiting room functioning. This model was designed to assist healthcare workers through the entire process of evidence-based change. Kurt Lewin’s change model was used to facilitate staff’s adaptation to change. Methods: Collected data included outcome measures of door to triage time, triage to room time, and room to physician time. Data was obtained monthly, starting in December and concluded in March. Findings/Results: Originally a rapid cycle of time process of employing time intervals with the initiated GRASP ED was to be used. However management recognized the potentital value of the implementation of the GRASP-RN and mandated staff participation in the project resulting in a transformational rather than incremental change in the triage process. Immediate change was implemented the first day of the process. Available data demonstrated minimal change in outcome measures following implementation of the GRASP-RN; however, data will be mined every 6 weeks after implementation and improvement in the stated is expected. Conclusion: GRASP-RN nurses are needed to improve the triage process and imperative to ensuring the waiting room is safe.
