Improving Emergency Department Throughput: Implementation of a Nurse-Driven Protocol in Pediatric Fast-Track Patients Presenting with Fever

Author

• Kerrigan A. Teeple, Valparaiso University

Date of Award

5-5-2026

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Christina Cavinder

Abstract

Overcrowding in the emergency department presents significant operational challenges and is associated with adverse patient outcomes (Gottlieb et al., 2020). Despite throughput initiatives, increasing patient acuity and rising census levels continue to strain emergency department efficiency. This quality improvement project evaluated whether implementing a fever-reduction standing order protocol could reduce door-to-provider and door-to-disposition times for pediatric fast-track patients presenting to the emergency department. A review of evidence across 6 databases identified nurse-initiated standing orders as a best-practice strategy to expedite care, improve throughput, and reduce delays in disposition. Guided by this evidence, a standing order protocol for acetaminophen administration was implemented during historically high-volume seasons in an urban pediatric emergency department. Eligible patients were 0–18 years old, febrile on arrival (>38°C), assigned an emergency severity index (ESI) acuity level of IV or V, and designated as fast-track. Nurses received education and training on protocol initiation. Data was collected from electronic health records and nursing leadership to evaluate outcomes. During implementation, 4,352 patients met criteria, with 109 receiving the protocol. Median door-to-provider time decreased from 46 to 38 minutes (17.4%), while median door-to-disposition time increased slightly from 116 to 118 minutes (1.7%). Rates of patients leaving without being seen remained stable, decreasing from 107 to 100 despite significant changes in census. These findings suggest nurse-initiated standing order protocols may improve emergency department throughput. Broader implementation, including use among higher-acuity pediatric populations, may further enhance operational efficiency and patient flow.

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Recommended Citation

Teeple, Kerrigan A., "Improving Emergency Department Throughput: Implementation of a Nurse-Driven Protocol in Pediatric Fast-Track Patients Presenting with Fever" (2026). Evidence-Based Practice Project Reports. 218.
https://scholar.valpo.edu/ebpr/218