Impact of Emergency Department Intake Workflow on Patient Safety, Quality Outcomes, and Nursing Practice
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Practicum Site Description
My practicum site is the Emergency Department at Advocate Health, a community-based acute care hospital serving ___ County and the surrounding rural areas of North Carolina. The emergency department provides 24-hour care to adult and pediatric patients experiencing medical, surgical, traumatic, and behavioral health emergencies. The patient population frequently includes individuals presenting with respiratory distress, chest pain, stroke symptoms, sepsis, trauma, and mental health crises. Many patients also have chronic conditions such as hypertension, diabetes, chronic obstructive pulmonary disease, and heart failure, which increase care complexity and resource utilization.
The emergency department employs approximately ___ full-time healthcare staff, including registered nurses, physicians, advanced practice providers, respiratory therapists, technicians, and ancillary personnel. In my role as a registered nurse, I participate in triage prioritization, patient assessment, medication administration, escalation of care, and interdisciplinary communication. While overall workflow decisions are determined by leadership, bedside nurses provide direct input related to patient safety concerns and operational challenges.
Primary Patient Health Outcomes
Primary patient outcomes at the practicum site include timely evaluation and treatment, prevention of clinical deterioration, reduction of adverse events, patient satisfaction, and efficient patient throughput. Emergency departments also focus on minimizing left-without-being-seen rates and ensuring rapid intervention for time-sensitive diagnoses such as sepsis, acute coronary syndrome, and respiratory compromise.
Identification of the Process Issue
The primary process issue identified involves the current emergency department intake workflow. Nurses are required to initiate care for multiple patients in intake areas without consistent room placement, continuous monitoring capability, or assignment of a primary nurse. High-acuity patients may remain in intake spaces while nurses simultaneously manage assigned treatment rooms. This fragmented approach places patients with conditions such as sepsis, chest pain, and respiratory distress at increased risk for delayed assessment and intervention, negatively impacting outcomes.
Summary of the Healthcare Process Problem
The intake model prioritizes patient throughput over safe staffing alignment and clear ownership of care. Nurses are expected to complete intake assessments, initiate orders, and monitor multiple patients while maintaining responsibility for roomed patients. This results in frequent task switching, inconsistent reassessment, and delayed medication administration. Additionally, variability in staff engagement contributes to uneven workload distribution. When intake responsibilities are not shared consistently, engaged nurses absorb additional tasks, increasing fatigue and reducing situational awareness. Evidence shows that high cognitive workload and interruptions significantly increase the likelihood of missed care and clinical errors (AHRQ, 2022).
Context and Significance of the Problem
Emergency department crowding and intake delays are associated with increased mortality, prolonged length of stay, and decreased patient satisfaction (Centers for Medicare & Medicaid Services [CMS], 2023). Delays in emergency care also worsen outcomes for sepsis and cardiac patients, where minutes directly affect survival (CDC, 2024). At the practicum site, intake congestion combined with inconsistent staff participation leads to: Delayed reassessment of high-risk patients, Inconsistent vital sign trending, Delayed initiation of ordered treatments, Increased nurse stress and moral distress. These conditions create preventable safety risks and place additional liability on bedside nurses.
Impact on Organization and Patient in Terms of Quality, Safety, and Cost
Quality: Delays in care negatively affect patient experience scores and increase left-without-being-seen rates. CMS identifies timely emergency care as a core quality indicator.
Safety: Fragmented monitoring increases the risk of unrecognized deterioration. High workload and inadequate staffing are directly linked to medication errors and adverse events (AHRQ, 2022). Variability in staff accountability further decreases the reliability of care delivery.
Cost: Organizational costs include increased admissions, prolonged emergency department length of stay, staff turnover, and potential legal exposure related to adverse outcomes. Nurse burnout also contributes to costly workforce instability (National Academy of Medicine, 2022).
Causes and Root Cause Analysis
Contributing factors include inadequate staffing models, lack of designated intake nurse roles, inconsistent accountability expectations, and variable staff engagement. These factors create a system dependent on individual effort rather than standardized processes.
The root cause appears to be a workflow structure emphasizing intake volume without aligned staffing or clear ownership of patients. Research shows that when accountability structures are weak and staffing is insufficient, patient safety declines and nurse burnout increases (Press Ganey, 2023).
Conclusion
The current intake workflow at Advocate Health Emergency Department presents significant risks to patient safety, care quality, and organizational sustainability. High-acuity patients are vulnerable to delays, while nurses experience increased workload and moral distress. Addressing this issue through staffing alignment, defined intake roles, and accountability expectations are essential to improving outcomes and protecting both patients and healthcare professionals.
References
Agency for Healthcare Research and Quality. (2022). Emergency department crowding and patient safety.
Centers for Disease Control and Prevention. (2024). Emergency department visits and patient outcomes.
Centers for Medicare & Medicaid Services. (2023). Emergency department throughput measures.
National Academy of Medicine. (2022). National plan for health workforce well-being.
Press Ganey. (2023). Nurse engagement, burnout, and patient safety outcomes.