Presentation
Identification, Redesign, and Evaluation of the RN Patient Arrival Process in a Large Hospital Emergency Department
DescriptionBackground
Nursing staff attrition poses a major challenge for hospital systems, with burnout and safety concerns being primary drivers of staff turnover (Mohamed et al., 2024). As emergency departments (EDs) face higher patient volumes, ED nurses are specifically vulnerable to stress and fatigue, making attrition a serious threat to system operations.
Research on front-end ED operations (patient arrival, triage, waiting room management) has focused on designing and measuring the success of clinical support tools, environmental interventions, and technological solutions related to patient care. Previous studies have evaluated the importance of front-end processes, particularly the use of digital check-in and triage systems (Sehgal et al., 2024); however, there is a gap regarding examining and redesigning the front-end ED staff workflows. When workflow-specific interventions are not considered in a redesign, integration with existing systems can add to nurse workload in an already stressed environment. The central aim of this research is to evaluate differences in nurse workflows, satisfaction, and ED throughput before and after the redesign of the patient arrival (or “quick look”) process in the hopes of improving system efficiency and supporting nurse perceptions of their role, reducing burnout and attrition.
Purpose Statement
Increasing rates of patient crowding, higher patient acuity, and safety concerns are among several factors that are associated with staff burnout and attrition in clinical settings. The “quick look” process that takes place as each patient checks into the ED may contribute to increased stress for RNs as they navigate the several tasks associated with the process. This study evaluates the current state of the ED patient check-in process; identifies elements of the process that inhibit RN workflows, staff satisfaction, and ED throughput; and provides recommendations for redesigning the check-in process to improve workflows, satisfaction, and throughput.
Methods
This study was conducted at an 864-bed tertiary referral hospital in an ED that treats over 106,000 patients annually. Data were collected both pre- and post- redesign via observations by the research team. Nurse workflows were evaluated using task analysis. Researchers observed 90 patient arrivals equally distributed across mornings, afternoons, and evenings in the ED to map nurses’ check-in workflows. As the patient arrival process was underway, the researcher documented each step of the RN’s process from start to finish, documenting any interruptions and decision points. Process throughput was measured using a time study. Researchers observed 90 patient arrivals, with the same equivalent time distribution, but recorded the duration of each process element that occurred during check-in. Nurse perceptions of job satisfaction and safety were measured using a survey including elements of the Kuopio University Hospital Job Satisfaction Scale (KUHJSS) (Sapountzi-Krepia et al., 2017) to gain a better understanding of nurse perceptions surrounding their role in checking in patients and sense of safety managing the ED waiting room. Observations of workflows and measures of throughput and nurse satisfaction were collected both pre- and post- process redesign.
The redesign of the check-in process was facilitated by a combination of interviews with ED staff and focus groups. Semi-structured interviews were conducted with nurses, ED leadership, and other ED staff. Interviews collected data regarding the check-in process, notable pain points and challenges of the process and the physical environment of the workstation and ED waiting room, sources of inefficiencies, and perceptions surrounding safety and security. Interview transcripts were analyzed to identify requisite needs (Ulrich et al., 2020) of the redesigned process. Analysis of needs statements were then used to highlight recurring issues and inform creation of design elements presented to facilitate co-design in the focus groups.
Results
Results of this study are ongoing as qualitative analysis of participant semi-structured interviews is underway. Data collection and analysis are anticipated to be completed by December 2025.
Discussion
This study highlights the importance of participatory design and human factors principles in the design of workflows in health care settings. Using observations, surveys, interviews, and focus groups, this research reveals how ED check-in processes are complex, increasing the demands placed on the nurses. Collected data are being analyzed to guide creation of design components promoting co-design in focus groups. Focus groups are expected to serve as critical validation stages of the redesign process prior to implementation. The results of the study are expected to generate meaningful insights into how front-end ED processes can be redesigned to support nursing staff well-being and hospital metrics and goals. This work will reveal key workflow adaptations by nurses and identify common inhibitors to standardized work in front-end ED processes, allowing for the development of well-rounded design options that reduce workload for staff. The redesign is expected to improve nurse perceptions surrounding their role at the “quick look” desk and streamline throughput and check-in efficiency.
Conclusion
This research provides specific workflow and physical workspace interventions to a frontline ED check-in process which serves as a basis for future analyses of nursing workflows. Given increasing concerns surrounding nurse burnout, staff attrition, perceptions of job satisfaction and safety, and throughput, this study provides a template for redesigning processes to accommodate staff concerns and promote patient safety and process efficiency.
Nursing staff attrition poses a major challenge for hospital systems, with burnout and safety concerns being primary drivers of staff turnover (Mohamed et al., 2024). As emergency departments (EDs) face higher patient volumes, ED nurses are specifically vulnerable to stress and fatigue, making attrition a serious threat to system operations.
Research on front-end ED operations (patient arrival, triage, waiting room management) has focused on designing and measuring the success of clinical support tools, environmental interventions, and technological solutions related to patient care. Previous studies have evaluated the importance of front-end processes, particularly the use of digital check-in and triage systems (Sehgal et al., 2024); however, there is a gap regarding examining and redesigning the front-end ED staff workflows. When workflow-specific interventions are not considered in a redesign, integration with existing systems can add to nurse workload in an already stressed environment. The central aim of this research is to evaluate differences in nurse workflows, satisfaction, and ED throughput before and after the redesign of the patient arrival (or “quick look”) process in the hopes of improving system efficiency and supporting nurse perceptions of their role, reducing burnout and attrition.
Purpose Statement
Increasing rates of patient crowding, higher patient acuity, and safety concerns are among several factors that are associated with staff burnout and attrition in clinical settings. The “quick look” process that takes place as each patient checks into the ED may contribute to increased stress for RNs as they navigate the several tasks associated with the process. This study evaluates the current state of the ED patient check-in process; identifies elements of the process that inhibit RN workflows, staff satisfaction, and ED throughput; and provides recommendations for redesigning the check-in process to improve workflows, satisfaction, and throughput.
Methods
This study was conducted at an 864-bed tertiary referral hospital in an ED that treats over 106,000 patients annually. Data were collected both pre- and post- redesign via observations by the research team. Nurse workflows were evaluated using task analysis. Researchers observed 90 patient arrivals equally distributed across mornings, afternoons, and evenings in the ED to map nurses’ check-in workflows. As the patient arrival process was underway, the researcher documented each step of the RN’s process from start to finish, documenting any interruptions and decision points. Process throughput was measured using a time study. Researchers observed 90 patient arrivals, with the same equivalent time distribution, but recorded the duration of each process element that occurred during check-in. Nurse perceptions of job satisfaction and safety were measured using a survey including elements of the Kuopio University Hospital Job Satisfaction Scale (KUHJSS) (Sapountzi-Krepia et al., 2017) to gain a better understanding of nurse perceptions surrounding their role in checking in patients and sense of safety managing the ED waiting room. Observations of workflows and measures of throughput and nurse satisfaction were collected both pre- and post- process redesign.
The redesign of the check-in process was facilitated by a combination of interviews with ED staff and focus groups. Semi-structured interviews were conducted with nurses, ED leadership, and other ED staff. Interviews collected data regarding the check-in process, notable pain points and challenges of the process and the physical environment of the workstation and ED waiting room, sources of inefficiencies, and perceptions surrounding safety and security. Interview transcripts were analyzed to identify requisite needs (Ulrich et al., 2020) of the redesigned process. Analysis of needs statements were then used to highlight recurring issues and inform creation of design elements presented to facilitate co-design in the focus groups.
Results
Results of this study are ongoing as qualitative analysis of participant semi-structured interviews is underway. Data collection and analysis are anticipated to be completed by December 2025.
Discussion
This study highlights the importance of participatory design and human factors principles in the design of workflows in health care settings. Using observations, surveys, interviews, and focus groups, this research reveals how ED check-in processes are complex, increasing the demands placed on the nurses. Collected data are being analyzed to guide creation of design components promoting co-design in focus groups. Focus groups are expected to serve as critical validation stages of the redesign process prior to implementation. The results of the study are expected to generate meaningful insights into how front-end ED processes can be redesigned to support nursing staff well-being and hospital metrics and goals. This work will reveal key workflow adaptations by nurses and identify common inhibitors to standardized work in front-end ED processes, allowing for the development of well-rounded design options that reduce workload for staff. The redesign is expected to improve nurse perceptions surrounding their role at the “quick look” desk and streamline throughput and check-in efficiency.
Conclusion
This research provides specific workflow and physical workspace interventions to a frontline ED check-in process which serves as a basis for future analyses of nursing workflows. Given increasing concerns surrounding nurse burnout, staff attrition, perceptions of job satisfaction and safety, and throughput, this study provides a template for redesigning processes to accommodate staff concerns and promote patient safety and process efficiency.
Event Type
Oral Presentations
TimeWednesday, March 2511:30am - 12:00pm EDT
LocationMurray Hill West
Hospital Environments