Several existing problems precipitated the creation of the triage system implemented by Kathryn Angell in an effort to deliver improved medical care. The main problem was a lack of coordination in service delivery. This lack of coordination caused excessive wait times on the order of anywhere from 23 to 40 minutes to see a nurse, 40 to 50 minutes to see a doctor, and as long as 55 minutes to get a prescription filled. The practice of all nurses being involved initially in seeing all patients caused duplication of efforts, including repeating questions and examinations, and resulted in procedural bottlenecks. Additionally, there were inconsistent levels of service and extreme variation in treatment because of the different experience and skill levels of the nurses. The overall view by patients was that the clinic was inefficient and impersonal.
The triage system was introduced in September 1979 to overcome these problems. One of the immediate changes was to establish a preliminary evaluation and referral system which dedicated two triage coordinators (highly experienced nurses) to evaluate the patients and assign them to the next appropriate step in the treatment process (i.e., seeing a nurse practitioner or physician). Unfortunately this process did not result in greater procedural efficiency. Wait time for a patient to see a triage coordinator was about 20 minutes, with an additional 38 minute wait to see the nurse or physician. In fact, according to Exhibit 5 in the reading, the wait time to see physician actually increased from 10 minutes to 25 minutes. The wait time for those seeing a specific provider increased from 25 minutes to 34 minutes.
There were several causes for the long waiting times in the Walk-In Clinic after the triage system was created. First, ...