A multi-disciplinary team was formed to review the Department of Emergency Medicine process in Singapore.

The team set the current Department of Emergency Medicine performance as the baseline, and after analysis, met with management and agreed to work toward three main objectives: (1) reducing patient waiting time; (2) improving the staffing and workload; and (3) improving key patient concerns by reducing the number of steps in the process and increasing communication. A patient and information flow analysis chart was mapped to scrutinize the entire process and to identify opportunities for improvement. Triage before registration was identified as one of the key initiatives. This eliminates the need to register and wait before the first point of clinical contact (triage). Visits were made to other hospitals to gain fresh insights and current literature was studied to learn more about worldwide trends and improvements. Weekly meetings were held to craft the implementation plan. Presentations were made to the Department of Emergency Medicine staff and management to get feedback and buy-in.

Triage before registration would reduce the waiting time by approximately seven minutes for each patient (with potential for further savings with the streamlining of the triage process). Resuscitation and critical care patients who require more expeditious treatment also will be identified earlier, leading to a better clinical outcome. Triage before registration also results in patients that are seen earlier by a staff nurse who can order tests and treatment as the patient waits for consultation. The empowerment of nurses to initiate more tests and treatment before consultation will improve patient experience and reduce downstream delays. The Patient Care Assistant at the test/treatment station will reduce the workload of the triage nurse conducting additional tests and speed up the triage process. Patient flow is streamlined and congestion at the waiting area is reduced.

Triage before registration significantly reduces overall waiting time and improves patient experience.