An observational and simulation study comparing a pivot nurse with traditional triage model for increasing patient flow through the emergency department

Mrs Janine O’keefe1, Mrs Jane  Congdon, Mr Luke Wainwright

1Emergency Department Caboolture Hospital, Caboolture, Australia


Triage is the first point of contact for patients presenting to the Emergency Department (ED), and is one of several processes that can negatively impact patient flow through the department contributing to increased patient length of stay.  ED waiting rooms have been identified as high risk, high liability areas for patients, minimising the time to be seen by a physician correlates with increased patient satisfaction and reduction of risk.

The pivot nurse model involves a quick assessment by an experienced nurse at the point of entry, producing minimal documentation but including chief complaint and Australasian Triage Scale category.  Compared with traditional triage, the primary difference for the pivot process lies in the omission of additional tasks and extensive documentation.


This submissions aim is to describe the planning and implementation of the pivot nurse model in a regional emergency department and the supportive flow models.


The pivot nurse at triage has the potential to enhance patient flow in the Emergency Department.


This observational study measured the time taken for patient triage in an Australian public ED and compared it to a simulated pivot nurse triage model.  We will report on an observational study comparing data from four sources: 1) Retrospective data for ED triage times over one year, 2) Real time observation of the time taken for patients to reach triage from time of entry to ED, 3) Simulation data for triage time using a pivot nurse model and, 4) Real time observation from the implementation of the pivot model.


The pivot nurse simulation saw six times more patients in the same timeframe as the traditional model.


The pivot nurse model may significantly reduce the time that all patients including the critically ill spend waiting to be seen in a busy ED.


My current role is the Clinical Nurse Consultant at Caboolture Hospital, Emergency department.  I have been an employee of Caboolture hospital for the past 25 years, 22 of these years have been in the emergency department.  I have witnessed many changes and challenges in the Emergency department over my career.  I have a passion for change management and improving processes to deliver a high standard of patient care whilst promoting a positive work culture for the staff. My qualifications include Bachelor of Nursing, Cert IV in Training and Assessment and more recently successfully completing Advanced Diploma in Leadership.  I recently travelled to the USA with our leadership group to look at models of emergency care; this has assisted in the development of the models of care that we will be introducing at Caboolture.