Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2020


Doctor of Nursing Practice (DNP)

Primary Advisor

Joyce Pulcini, PhD, PNP- BC, FAAN; Asefeh Faraz, PhD, APRN, FNP- BC


emergency department, provider in triage, triage


Background: This project implemented a Provider in Triage (PIT) system in a small emergency department (ED) in Washington State. The employment of a PIT to decrease patient waiting time and improve ED flow was supported by a literature review. A needs assessment was conducted, which indicated potential benefit from a PIT system, particularly because several ED metrics are worse than national average.

Aims/Objectives: This project aimed to develop, implement, and evaluate a PIT system by employing ED Advanced Practice Clinicians (APCs). The objectives consist of evaluating the impact of a PIT system on the percentage of patients who leave without a provider examination (LWBS), the length of time from ED patient arrival to provider examination (DTP), discharge (DTD), and/or admission (DTA).

Methods: The APC worked as PIT when the ED was full, with four patients waiting. Metrics including LWBS, DTP, DTD, and DTA were evaluated with SPSS 25. The control group involved patients from one year prior to the implementation of the PIT system. Control variables were considered using regression.

Results: Chi square analysis revealed that a PIT system had no impact on LWBS. Independent t tests found that PIT had no significant impact on DTD or DTA but was associated with a longer DTP. IMPLEMENTATION OF A PROVIDER IN TRIAGE 6

Conclusions: This DNP project did not lead to critical positive findings. However, confounding factors, including provider variation, nurse staffing, and census, could have influenced the significance of the results. A larger study with a control group matched for daily census is suggested for further research.

Available for download on Wednesday, April 14, 2021

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