Enhancing Streaming and Triage in the ED- A New Approach
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Authors
B Moran
H Bhandal
J Kennedy
H Dunn
B Parker
V Oji
O Spencer
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Issue Date
2025
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Abstract
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Abstract
Background:
Emergency department (ED) overcrowding remains a major challenge in healthcare delivery. Enhanced Streaming and Triage (EST) models have emerged to optimise patient flow, resource use, and clinical outcomes. EST combines structured patient assessment with targeted care pathways, directing patients into distinct treatment streams after initial triage to match specific care needs more effectively.
Aim:
To demonstrate that, following implementation of EST on 3rd March 2025, patients are streamed, triaged, seen by a Clinical Decision Maker (CDM), and receive a clinical decision faster compared to the previous system.
Methods:
We compared two patient groups: 5410 adults attending the ED from 1st February to 2nd March 2025 (pre-EST) and 5351 from 3rd March to 15th April 2025 (EST). Only patients arriving between 08:00–20:30 were included, as EST was not active overnight. Variables analysed included time from arrival to key ED stages—Streaming, Triage, Additional Nursing Assessment, Seen by and Decision Made by a CDM—as well as the proportion requiring further nursing assessment. Paired t-tests were used for statistical comparison.
Results:
Post-EST implementation, the average time from arrival to nursing assessment fell from 48.64 to 27.85 minutes (p<0.001), and arrival to triage completion dropped from 21.48 to 2.85 minutes (p<0.001), nearly 10 times faster and within the 5-minute target in the Enhanced Triage SOP. Patients needing further nursing assessment decreased significantly from 43.9% to 9.8% (p<0.001).
The median time from blood test request to result remained at 79 minutes.
Time from arrival to CDM review decreased - 102.93 to 95.38 minutes (p<0.001), as did time to clinical decision: 202.62 to 177.76 minutes (p<0.001). Time from first being seen by a CDM to decision also dropped from 99.69 to 82.38 minutes.
The proportion of patients receiving a clinical decision within 4 hours of arrival rose from 72.55% to 81.2%, the highest since November 2021. Patient-reported satisfaction improved, with the proportion rating their experience as Good or Very Good increasing from 73.76% to 81.3%.
Conclusion:
EST significantly improved ED flow, reducing time to assessment, triage, CDM review, and clinical decisions. The decline in patients needing further nursing assessment suggests better early patient categorisation. While lab turnaround time remained unchanged, improved use of that period for observations and ECGs enhanced care efficiency. These results support EST as an effective model for aligning ED processes with patient needs.
Recommendations:
EST should be expanded to operate at all hours as well as increasing staff training protocol adherence through regular education and support. Going forward, patient outcomes with EST should be tracked to inform any future improvement and it is important to assess longer-term impacts on patient safety, satisfaction, and care quality through continuous data collection.
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QUALITY IMPROVEMENT PODIUM PRESENTATION WINNER (2025)