Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Melanie Hardin-Pierce

Committee Member

Dr. Debra Hampton



Purpose: To evaluate effectiveness and timeliness of through-put in the emergency department based on provider type in a rural critical access hospital in eastern Kentucky.

Design: A retrospective, observational review was conducted at a small critical access hospital. Descriptive statistics including Mann Whitney and Chi square were performed to evaluate significance.

Methods: Pre-intervention 552 charts were abstracted and 1656 post-intervention charts were abstracted. Arrival time to triage, triage to provider and provider to disposition times in minutes were collected. A prospective survey regarding comfort level with performing advanced practice skills was given to the advanced providers who were working in the emergency department.

Results: There was a decrease in arrival to triage, triage to provider and provider to disposition. However, the only decrease to show statistical significance was the triage to provider time.

Conclusion: While times improved for emergency department through-put no sustained significant change was noted for the overall study. The majority of advanced care providers felt uncomfortable performing certain advanced practice skills. Further study and education is needed to evaluate provider specific effects on through-put as well as effects of patient education on triage by acuity, signage in the lobby educating patients and visitors that patients are taken into triage by severity of illness to determine effects of through-put and patients leaving without treatment. Triage to provider was improved, however there is more that could be studied to improve timely patient care and decrease AMA and LWOBS in the emergency department.

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