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Date of Award


Degree Type

Restricted Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Theresa A. Kessler


Using protocols in triage can facilitate a patient's movement through the emergency department (ED), thus decreasing length of stay (LOS) (Yoon, Steiner, & Reinhardt, 2003). The purpose of the evidence-based practice (EBP) project was to develop an algorithm with associated protocols that specifically focused on a respiratory nature of shortness of breath. The clinical question examined was: In adult patients with shortness of breath, what is the effect of a triage respiratory algorithm and protocols on LOS in the emergency department compared with not using an algorithm and protocols for patients who are processed at an acuity level of three or four? The EBP project methodology was guided by The Iowa Model. A prospective sample of adult patients, age 19 and over, were included in the project. A nurse-initiated algorithm was developed based on the highest severity and most frequent diagnoses of asthma, COPD, and pneumonia. The algorithm and protocols were implemented over a four month period at a community hospital ED. Data collection occurred through a chart review. Variables included demographic information, time intervals throughout the ED process, the acuity level, and the final disposition diagnosis. Analysis included descriptive statistics and between group comparisons for pre- and post- algorithm and protocol implementation. The primary outcomes examined were the total LOS (TLOS) in the ED, arrival to bed assignment (ARR-BED), and the interval from when the provider assessed the patient to the disposition time (PPA-LOS). Time-savings occurred for TLOS (3 min.) and PPA-LOS (6 min); however, ARR-BED demonstrated a 5-minute increase in time. There were no significant differences found. Treatment protocols must be initiated prior to the medical provider assessment to decrease LOS. Further research is needed to verify previous studies that demonstrate nurse's ability/appropriateness to request diagnostic testing prior to the medical provider assessment.