A lifeguard has to be on guard for situations that may not look like drowning but are dangerous nonetheless. In the same way, triage nurses must be able to identify patients in the emergency department who may be sicker than they let on.
At the session “The ‘First Look’ Nurse: Reducing Door-to-Triage Times,” the speakers discussed how the first-look nurse role significantly decreased door-to-triage times at Inova Loudon Hospital.
This is why Lauren Clarke, BSN, RN, CEN, TCRN, a unit supervisor at Inova Loudon Hospital in Leesburg, Virginia, referred to triage nurses as the lifeguards of the emergency department in yesterday’s session “The ‘First Look’ Nurse: Reducing Door-to-Triage Times.” Some of the patients making the least fuss, she stressed, actually are the ones in the most trouble. Her department’s solution: implementing a “first look” nurse to assess people quickly.
First Things First
“We knew that there had to be a better way for us to manage our triage, get quicker eyes and ears on our patients, and kind of make that sick-versus-nonsick assessment as quickly and accurately as possible,” Clarke said, explaining the department’s decision to initiate changes four years ago.
The ED decided it needed a first-look nurse between the peak hours of 11 a.m. and 11 p.m. This nurse collects the patient’s chief complaint, heart rate and oxygen saturation, and enters a brief note and initial ESI level into the EPIC system. If the patient is deemed acutely ill, they are escorted to a room quickly. If not acutely ill, they may be sent back to the waiting room. The important thing is they’ve been seen by a provider, which makes them feel less stressed and builds trust.
The department engaged in a physical redesign to accompany the new position. Before, the registration desk and triage nurse were essentially disconnected from each other. Neither had a direct sight line to the entire waiting room. “We repositioned our staff to be able to see every patient that entered the front door of our emergency department,” said Lisa Wells, BSN, RN, TCRN, a unit supervisor at Inova Health System. “We placed our first-look nurse next to the registration, so they could immediately start the triage process.”
Long-Term Solution
The payoff has been beyond what staff expected. “When we first analyzed our data, we were so thrilled to see that our door-to-triage time had been reduced by 67 percent,” said Lindsay Schoem, BSN, RN, TCRN, a trauma nurse specialist at Inova Health System. “That’s a tremendous win on its own.”
When the team added the results from shifts between 11 a.m. and 11 p.m. during the first quarter of 2025, however, the gains were through the roof. “We achieved an 88 percent reduction in door-to-triage time,” said Schoem. “We went from a median of 15 minutes to two. That’s not just better — that’s transformational.”
The seamlessness of the process between 11 a.m. and 11 p.m. has bled into other shifts, which also have seen reduced door-to-triage times. In fact, the Inova Loudon employees have been so satisfied with the new process that they’ve introduced it to the other four hospitals in the Inova system.
“What’s most encouraging is that these improvements haven’t been temporary — they’ve been sustained,” Schoem said. “This shows that changes weren’t just a quick fix but a lasting transformation in how we deliver safer, efficient care.”