• Stella S Falconer, Corinne M Karuppan, Emily Kiehne, and Shravan Rama.
• Springfield, MO; St. Louis, MO; Iselin, NJ. Electronic address: Stella.Falconer@Mercy.net.
• J Emerg Nurs. 2018 Nov 1; 44 (6): 589-597.

ProblemVital signs can result in an upgrade of patients' Emergency Severity Index (ESI) levels. It is therefore preferable to obtain vital signs early in the triage process, particularly for ESI level 3 patients. Emergency departments have an opportunity to redesign triage processes to meet required protocols while enhancing the quality and experience of care.MethodsWe performed process analyses to redesign the door-to-vital signs process. We also developed spaghetti diagrams to reconfigure the patient arrival area.ResultsThe door-to-vital signs time was reduced from 43.1 minutes to 6.44 minutes. Both patients and triage staff seemed more satisfied with the new process. The patient arrival area was less congested and more welcoming.DiscussionPerforming activities in parallel reduces flow time with no additional resources. Staff involvement in process planning, redesign, and control ensures engagement and early buy-in. One should anticipate how changes to one process might affect other processes.Copyright © 2018. Published by Elsevier Inc.

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