Homerton Emergency Department rolls out eTriage to help reduce waiting times


Homerton University Hospital in east London has rolled out an electronic check-in service in its Emergency Department that combines eTriage by eConsult Health with Cerner’s Millennium electronic patient record (EPR) system.

The implementation will strengthen the hospital’s ability to meet its government-set target of assessing walk-in patients within 15 minutes. By accelerating the process of prioritising and triaging patients in urgent care (UC) centres and emergency departments (EDs), the solution will also significantly reduce waiting times and enhance patient safety.

eTriage – an electronic check-in service that uses algorithm-based questions about symptoms and medical history – quickly identifies the sickest patients and categorises walk-ins into five different priority categories (P1 – P5). The end-to-end system integrates eTriage with the hospital’s workflow and Cerner’s clinical software and will process 350 walk-in patients per day, with a projected average completion time of 5.4 minutes (based on data from over 250,000 patient journeys in A&E departments using eTriage).

Speeding up time-to-assessment has a range of benefits for the hospital, its clinical and administrative staff and its patients which are listed below.

Improving patient safety: eTriage ensures that patients requiring urgent medical attention are immediately identified and flagged within the hospital’s EPR system. This is particularly important for patients presenting at A&E with symptoms of a heart attack or sepsis for whom the ‘golden hour’ can be the difference between life and death.

Freeing up clinical time: Face-to-face triage is a time-consuming process that requires an assessment nurse to take a history, obtain a set of vitals, and potentially conduct a urine dip or ECG. By accelerating this process, eTriage enables nurses to focus on communicating with people in the waiting room, as well as diagnosing and treating patients inside the hospital.

Quick Covid-19 screening: All self-assessments start with a series of questions designed to identify potential Covid-19 cases. Patients presenting with symptoms consistent with the virus are flagged and directed to a ‘red zone’ inside the hospital before entering the main waiting room, protecting staff and patients.

Jean Lyon, Senior Nurse in the hospital’s Emergency Department said: “Homerton has a long history of successfully driving innovation to improve patient experience, and we have been working closely with eConsult and Cerner for the last six months to create this first-of-its-kind solution. We believe this new approach to assessing walk-in patients will have a really positive effect on our ability to treat patients and further improve their experience inside A&E. It will also futureproof the hospital for the next wave of government targets focused on time to assessment, time to recognition of deteriorating patients and total time in the emergency department. ”

The eTriage system will be the main pathway for UC/ED patients to check in on arrival at the hospital, with care navigators on hand to assist patients with using the platform. In advance of their triage, the system collects ECDS data from the patient. During triage, all questions are written in plain English and require a reading age of seven years old. The user interface is powered by touch and uses visual cues such as body maps and simple graphics to make it as easy and intuitive as possible for patients to describe their symptoms.

A recent study conducted by eConsult revealed that nearly two thirds (64 per cent) of UK patients who visited A&E in the last 12 months would feel confident or somewhat confident using an electronic self-check in system to speed up the triage process, with just 12 per cent against the idea. However, for individuals who are uncomfortable with – or unable to use – the eTriage tool, an in-person check in with a member of the reception team will still be available as an alternative.

Mark Harmon, Practicing A&E Doctor and Chief Strategy Officer at eConsult comments: “There is currently unprecedented pressure on A&E departments who have been hit with a wave of post-lockdown walk-ins and have faced one of the busiest and toughest winters on record. Against this backdrop, we are proud to partner with the team at Homerton and our friends at Cerner to deliver a solution that will help support clinicians, hospital staff and patients through this challenging period and beyond.”

In addition to accelerating time-to-assessment, Homerton anticipates that allowing patients to input their own demographic information will improve data integrity and accuracy and reduce transcription errors by third parties. Once the patient has submitted their self-assessment through the eTriage system, the information is seamlessly integrated into the Cerner Millennium ERP system and is flagged and colour-coded in order of clinical acuity.
In addition to this latest deployment at the Homerton in collaboration with Cerner, eTriage is currently live in nine Urgent & Emergency Departments including St Richard’s Hospital and Chichester Hospital Emergency Departments, and Queen Mary’s Hospital, Sidcup Urgent Treatment Centre.