Date of Award

Fall 2022

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Dr. Douglas J. Stephens, DNP, CRNP, ACNP-BC


Dr. Jenna Johnson


Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has resulted in superior health outcomes such as control of chronic diseases and decreased mortality or worsening symptoms. The ESI triage tool aims to improve patients' triage based on acuity. The triage protocol also has been shown to reduce door-to-provider time, walkouts, and emergent waiting room events.

Purpose: The quality improvement project is aimed at evaluating the significance of triage; minimizing door-to-provider times; lowering the risk of potential adverse events in the waiting area; eradicating perceived barriers to implementation, improving patient outcomes throughout the treatment process, and preventing adverse or near-adverse events.

Methods: Pre- and post-study design and PDSA model signified the use in this quality improvement project. The principal investigator utilized this design to evaluate the impact of incorporating the Emergency Severity Index triage system into urgent care centers.

Results: The average triage time for the pre-intervention and post-intervention periods were calculated separately. Average triage times pre-intervention was noted to be 45 minutes, while post-intervention triage times ranged between 17 and 18 minutes. Post-implementation data showed improvement in all areas, including identifying patients with urgent medical needs, quickly sorting patients in constrained resource settings, allowing triage nurses to project operation and resource needs, and supporting the discrimination of patients who should not be seen in the emergency department.

Conclusion: The triage protocol helped reduce door-to-provider time, walkouts, and emergent waiting room events. Implementing the ESI triage tool led to improved clinical practices and decreased wait times and adverse wait room events.


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