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Reassessing Patients in the Emergency Department Waiting Room
Dissertation

Reassessing Patients in the Emergency Department Waiting Room

Sarah Minaghan
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: Emergency department (ED) overcrowding has led to increasing numbers of patients waiting for extended periods prior to evaluation. Delays in reassessment of patients in ED waiting rooms have been associated with increased risk of clinical deterioration and adverse events. Purpose: The purpose of this quality improvement project was to implement a standardized reassessment process for patients in the ED waiting room and Team Triage area to support early identification of condition changes, improve patient safety, and increase patient satisfaction. Methods: This project was conducted in a large academic medical center ED using a Plan–Do–Study–Act framework. A protocol was implemented requiring reassessment of patient vital signs and condition every four hours while awaiting care. Data were collected through chart audits, patient satisfaction surveys, staff surveys, and review of reported adverse events. Findings: Reassessment completion was documented in 22% of audited encounters, below the project goal. Most staff respondents reported participating in the process and generally rated it as effective. Patient satisfaction remained high before and after implementation. Adverse events were reported during both the pre- and post-implementation periods. Discussion: Findings highlight the influence of staffing, workflow, and operational factors on implementation of safety initiatives in high-volume ED environments.
 emergency department overcrowding patient reassessment patient safety quality improvement

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