Using Volunteers at Triage

in the Emergency Department:

One Successful Program

N U R S E E D U C A T O R

Author: Irene Fortin, RN BSN, Rutland, Vt

Section Editor: Faye P. Everson, RN, CEN

Irene Fortin, is Emergency Department Nurse Educator, RutlandRegional Health Services, Rutland, Vt.

This study was supported by the Rutland Regional Medical Center’sEmergency Department and Volunteer Program.

For correspondence, write: Irene Fortin, RN BSN, Rutland RegionalHealth Services, 160 Allen Street, Rutland, VT 05701; E-mail:Ifortin@rrmc.org.

J Emerg Nurs 2006;32:340-2.

0099-1767/$32.00

Copyright n 2006 by the Emergency Nurses Association.

doi: 10.1016/j.jen.2006.04.017

340

vercrowding has caused the emergency depart-

Oment at Rutland Regional Medical Center, a

level 2 trauma center with approximately 35,000

emergency visits a year, to undergo some drastic changes

over the past few years. In 2004 and the first part of 2005,

there were days when the ED staff were ‘‘holding’’ 3 to

14 patients who were awaiting admission, as well as trying

to take care of the incoming emergency patient popula-

tion. The hospital administration realized this could not

go on because of the strain on both the ED staff as well

as on the hospital in general. In response to this situation,

we developed the Emergency Department Triage Volun-

teer Program. These volunteers assist the triage nurse and

direct patients, family members, and visitors at this point

of entry. Our hope was that this program would increase

patient and staff satisfaction.

The development of the program was quite accidental.

The nursing staff continually expressed their frustrations

with having to be the ‘‘traffic controller’’ at triage. The in-

terruptions were constant, and the triage process did not

f low smoothly. In March 2005, the ED Leadership Team

and the nurse educator invited the volunteer administra-

tive leader and the volunteer service coordinator to their

monthly meeting. The discussion was supposed to be about

the functions of the ED volunteer couriers and patient li-

aisons. (These 2 positions were used inside of the emergency

department and had nothing to do with the triage process.)

At the meeting, the nurse educator expressed a wish to

have volunteers in the triage area. The ED administrative

leader shared information on our very low patient satis-

faction scores and reported that several other institutions

were implementing programs involving greeters at various

JOURNAL OF EMERGENCY NURSING 32:4 August 2006

N U R S E E D U C A T O R / F o r t i n

entry points, to increase their scores. Many of these posi-

tions were salaried and we were unsure if our institution

would support another paid position. The volunteer ad-

ministrative leader and the volunteer service coordinator

listened to the concerns and asked for a job description

for a ‘‘triage volunteer.’’

Augu

These volunteers assist the triage nurseand direct patients, family members,and visitors at this point of entry.

Information on this topic is not readily available in the

nursing literature. However, many hospitals have a similar

program and have information available on their hospital

volunteer sites on the Internet. For example, Press-Ganey’s

Topic Forum in 2003 listed 3 institutions that have a simi-

lar volunteer greeter program.1 Two of these institutions,

Bayonne Medical Center in Bayonne New Jersey, and

Concord Hospital in Concord New Hampshire, use paid

staff in this role. The third, O’Bleness Memorial Hospital

in Athens Ohio, have both paid staff and volunteers work-

ing in their ‘‘ER concierge role.’’ The paid positions are

called ‘‘Patient Representatives’’ and act more like a pa-

tient liaison; the volunteers are the ‘‘Greeters.’’ We con-

tacted representatives from all 3 programs. All reported

increased patient satisfaction as a result of their programs.

Creating the program

Within days, the nurse educator had a job description

completed and sent it to the volunteer administrative leader

and the volunteer service coordinator for review. They

were shocked, and responded, ‘‘We think you’re serious!’’

The educator replied, ‘‘I’m desperate.’’

All agreed that it would take the ‘‘right’’ volunteer.

(Every facility contacted about this program mentioned

this important fact.) The volunteers would have to have

wonderful ‘‘people’’ skills: they needed to be mature, re-

sponsible, articulate, polite, and helpful. The focus was on

finding volunteers with real-life experience.2 It was agreed

that coverage would be required from 11 AM to 9 PM,

because of the increased census during these times.

The volunteer service coordinator began the recruit-

ment process in July 2005 and carefully screened new

st 2006 32:4

candidates. To our amazement none of the existing vol-

unteers felt this position was needed. A few comments were

as follows: ‘‘I don’t think I’ll be busy enough out there.’’

‘‘I don’t want to loose my courier role just to do that.’’

Finally, in September the volunteer service coordinator an-

nounced that she had found her volunteers. Three men and

1 woman agreed to be the first persons in the new role.

While the volunteer service coordinator was recruit-

ing, the educator had been developing a formal orientation

program for the role. Each triage volunteer was oriented

to the hospital by the volunteer service coordinator, includ-

ing 5 hours of formal hospital training, 2 hours of formal

couriers’ training, and 70 hours of practical experience in

the emergency department as a courier. Next, each went

through the nurse educator’s newly developed Triage Vol-

unteer Orientation program that included a brief tour of

the triage area, and a review of the volunteer’s job de-

scription and skill objectives. Then both the educator and

the volunteer carried out the actual job in triage, together.

This orientation took 2 hours and then the volunteer

worked alone for 2 more hours.

The Triage Volunteers have a desk from which they

greet patients and families and provide them with direc-

tions. They put the patient’s name, chief complaint, date

of birth, and time of arrival on the triage sheet and bring

this to the triage nurse. (This prevents the triage nurse from

being interrupted during the triage process.) The volun-

teers also help with our ‘‘left without being seen’’ popu-

lation, because they report to the ED staff when a patient

wants to leave. (In the first 2 quarters of 2006, the number

of patients who left without being seen decreased from

3% to 1%.) Other duties involve getting a copy of the

record from the last emergency department visit, keeping

all patients and family members who are in waiting rooms

informed of the wait times, and ensuring that the waiting

room is clean by notifying housekeeping staff, as needed.

Their primary role is maintaining traffic control, for which

the ED staff is grateful.

As they eased into the role, the nurse educator visited

them weekly. She then ‘‘signed them off’’ when both the

volunteers and the educator felt the new volunteers were

competent. All were signed off within a month. Now that

they have become established in their role, the group meets

with Leadership and the educator quarterly, and share ideas

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N U R S E E D U C A T O R / F o r t i n

about the program. All of the volunteers reported that they

wanted to continue in their role.

We recruited 3 more volunteers through January 2006,

thus allowing us to cover shifts from 11 AM to 4 PM on

weekdays. Gradually, we have been able to cover 2 evening

shifts as well as 1 weekend shift.

342

The volunteers help with our ‘‘leftwithout being seen’’ population, becausethey report to the ED staff when apatient wants to leave. In the first2 quarters of 2006 the number ofpatients who left without being seendecreased from 3% to 1%.

Results

Despite concerns about how this program would be re-

ceived by the ED staff, the staff, volunteers, and patients

have expressed satisfaction. According to our Press-Ganey

Scores, in March 2005, before the implementation of the

program, our overall ‘‘arrival’’ score was 76.1%. (This sec-

tion of the Press-Ganey tool includes 4 questions that are

directly related to the patient’s perception of their entry

into the department.) In March 2006, the score had in-

creased to 84.3%, a total improvement of 8.2%, due to the

work of the triage volunteers.

Recently we added a question to the ED Press-Ganey

questionnaire that asks about the helpfulness of the vol-

unteers. The score for this question on the first report was

91%. The volunteers believe they should achieve 100% all

the time, and are working toward that goal, thus ref lecting

the dedication of this special group of people.

Currently the program is running smoothly. We have

not made any changes to it since its start in September 2005.

The program continues to grow slowly and we anticipate

that this will continue because of the satisfaction it provides

to all stakeholders in the department and in the community.

REFERENCES

1. Press Ganey Associates, Inc. Forums-Greeters in ED. Available athttps://www.pressganey.com/forum. Accessed February 15, 2006.

2. Hummer C, Kino R. ED touched by angels slashes complaints:volunteers bring a human touch to patients. ED Manag 2004;16:103.

JOURNAL OF EMERGENCY NURSING 32:4 August 2006