Health Services Research

Should You Close Your Waiting Room?
This project is aimed at reducing overcrowding in the ED setting and is the Team Grant funded by the Emergency Medicine and Emergency Nursing Foundations. Dr. Gisondi is the Principal Investigator, Dr. Tanabe is a Co-Investigator. The aims of the project are to  1) determine the impact of a formal, structured process improvement protocol to close the ED waiting room when specific criteria are met, on the following outcome measures: patient arrival to placement in a treatment bay , total ED patient length of stay, total number of patients waiting greater than one hour for physician evaluation, and the proportion of patients left without being seen and 2) develop a tool-box with education and measurement tools useful to ED’s that will help guide successful implementation at individual EDs. Multiple sessions are being conducted with the ED staff to develop criteria of when to open and close the waiting room. These criteria will be tested to evaluate their affect on time to initial physician evaluation, overall length of ED stay and left without being seen.

Triage
Dr. Paula Tanabe works with national leaders in health services research including Drs. James Adams and Kevin Weiss to develop research projects that focus on improving the reliability and validity of a 5-level patient triage system, the Emergency Severity Index (ESI) triage instrument.

2003 - 2004: Dr. Tanabe, along with colleagues James G. Adams, MD, Kevin Weiss, MD, MPH, Z. Martinovich, PhD, N. Gilboy, RN, MSN, D. Travers, PhD, RN, and A. Rosenau, DO were awarded a grant from the National Emergency Nurses Foundation and Sigma Theta Tau for their project "Optimizing triage of high acuity patients: revision of the Emergency Severity Index (ESI) level 1 & 2 criteria." This was a multi-site project with the Brigham and Women's Hospital of Boston, the University of North Carolina, and Lehigh Valley Hospital Emergency Departments. Northwestern University is the coordinating center. This project is complete and has helped identify patient characteristics to redefine the Level 1 criteria to more accurately capture the highest acuity patients.

2004 - 2006: Dr. Tanabe has served as the Co-Chair of the National Emergency Nurses Association (ENA)/ American College of Emergency Physicians (ACEP) five-level triage task force that has made recommendations nationally regarding five-level triage systems. Dr. Tanabe is the co-author and co-editor of  Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 05-0046-2. Rockville, MD: Agency for Healthcare Research and Quality. Dr. Tanabe is also the co-leader of the two-DVD set training video that is part of the standardized training materials for the ESI. Both the book and DVD are available at the following website www.ahrq.gov/research/esi.