The Assumption of Risk
The assumption of risk in hospitals begins when a person presents for treatment. It is common knowledge that up to 50% of all
hospital admissions begin in the emergency department. While risk varies as patient treatment progresses from department
to department, it is safe to conclude that the one department which pre-empts all others in terms of percentages of signficant
risk is the emergency department. Focusing on addressing risk issues at that point of entry will significantly reduce overall
risks hospital-wide. This is why, when assessing overall hospital risk, it is imperative that you partner with Triage First
for solutions on risk reduction for your emergency department, leading to the overall risk reduction for your hospital.
Why We Are Different and Effective
in Reducing Risk
Our formula is simple. We (1) consult, (2) educate, (3) implement, and (4) provide a web-based portal through which to manage
tasks, teams, and timelines. As a function of the Triage First ED Evaluation, we review approximately 50 areas of concern in
the emergency department, each of which is associated with some level of risk. Following our presentation of the ED
Evaluation's findings, we will generally recommend that all ED staff be educated regarding the changes that are needed
because we believe the ED staff should "own" the change. Following the education of the staff, we begin our implementation
phase, using senior consultant assignments, Virtual Implementation Services (VIS), and the online ED CQI portal.
As one example of minimizing risk, Triage First consulted, educated, and implemented at "XYZ Hospital." This facility had a
four-tier triage system to expedite disposition from triage. Our consultants retrieved 181 ED charts at random, spanning a
period of 6 months. Of the charts which assigned acuities, the consultants made this exhibit of their findings:
The annual census at XYZ Hospital was 20,000 at the time of the consult. According to the documented acuity assignments, not
a single patient presented as "Emergent" during the 6-month period. Clearly, something is wrong with the acuity assignments
at this hospital. As a risk manager, you can easily sense the high level of risk there—just in this one area alone.
A very careful review was conducted of the presenting symptoms and nursing assessments from all 181 charts, and the findings
documented. Our consultants, using XYZ emergency department's own written criteria for appropriate assignments, amended all
charts and made this exhibit of their findings:
Twenty-eight patients presented to XYZ emergency room with symptoms that met their own criteria for what constituted an Emergency
but were either assessed and assigned Urgent or Semi Urgent at the time. These assignments consequently resulted in increasing
patient wait times, delayed or missed reassessments, increased patient dissatisfaction, and therefore risk was highly elevated
for this population in particular, but also carried over into other areas of process and care.
Examining other risk issues—Against Medical Advice, Left Prior to Medical Screening Exam, Elopement, Patient Complaints, Patient
Education, Transfers, Diversions, Delays in Treatment, Security and Patient Safety, and Patient Satisfaction—XYZ Hospital's
emergency department was found to be in a category of extreme high risk—the very reason XYZ Hospital requested Triage First's
expertise.
XYZ's emergency department administration team worked with Triage First until all of their issues (Triage First's findings) were
addressed, their staff educated, and the goals for this department were reached. The ROI for partnering with Triage First was
realized within months of the implementation phase start-up. Today, XYZ's emergency department enjoys a new ED culture which is
safer and more efficient, with an increase in patient satisfaction and a very significant reduction in risk.
Consider partnering with Triage First. Think risk. Think reduction. Think of us first.
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