The main lessons learnt from implementing a standardised triage tool in one health region in Norway, connected to the identified challenges and desired effects, and further categorised to the most relevant factors for successful implementation and sustainability
| Factors influencing successful QI (references) | Description of some challenges and desired effects | Lessons learnt |
| Identifying areas for improving quality and safety1 25 |
| A focus on the need for improved quality and safety regarding patient status and treatment was agreed on. A need for better communication, mutual understanding and cooperation about patients’ medical conditions between the EMS and EDs was recognisable and acceptable |
| Defining and agreeing on specific goals2 25 | Agreeing on common goals should reflect what we were trying to accomplish, to increase cooperation, effort,and unity during the QI process | Maintaining an overall focus on common, agreed on and well-known goals was important for motivation during the entire QI process |
| Organisational acceptance and financial support1 | Anchoring and securing necessary funds required preparatory work to provide a good foundation for the QI process | Full managerial support from leaders at various levels, as well as the employees, was crucial for the implementation itself, and for further follow-up and sustainability. Managerial support and acceptance provided funds and time for project work |
| Structuring the project5 | Systematic QI tools like the PDSA cycle, the “’Norwegian Patient Safety Programme’ and the IHI Model for improvement are usable frameworks to structure the QI work | Using PDSA as a framework for the project provided an opportunity for breaking the work down into smaller tasks; the Model for improvement endorsed by the Norwegian health authorities’ national system for QI in healthcare provided valuable support in this extensive QI work |
| Selecting and establishing the project group1 25 | Assembled an interdisciplinary group of key professionals among doctors, nurses and ambulance workers | Perspectives from the multidisciplinary team with specifically selected professionals added great value and provided invaluable insight that helped us reach our goals |
| Continuous and reliable information and feedback1 | Provided continuous information to all stakeholders regarding achieved results and challenges | Provide regular up-to-date information, adjust the amount to the phase of the process; be open about problems and challenges; communicate with the project participants; and stakeholders are more important than often assumed |
| Measurements1 25 | Selected key variables and sources and planning the data collection to evaluate the effect of interventions, including baseline data and evaluation data. A survey was performed to test whether the triage tool performed similar in all EMSs and EDs in the region | Selecting the right data was challenging and made us initially collect too much data; because the participants were not familiar with QI measurements (baseline and evaluation), we had to provide close follow-up and measurement guidance. The survey was useful, but be sure that a survey or a test was necessary, because a work of this size is an extensive endeavour to distribute, analyse and follow-up |
| Coaching and follow-up1 | Ensured continuous follow-up and coaching, if necessary | Peer-to-peer feedback and coaching was one of the most important factors during the whole QI process; being readily available and present for follow-up, even 24/7, as most emergency patients are seen outside normal office working hours |
| Teaching and training1 | Assessed the need for teaching material and offer support and training | There was a need to develop educational materials with accessible and clear presentation, user’s manual, guidelines, descriptions of work processes and new routines. Several and similar methods for teaching and training gave all EMSs and EDs identical opportunities for learning SATS-N in the same way |
| Implementing the new triage tool in the EMSs and EDs5 | Created a plan and reach consensus for a stepwise implementation process in the various health trusts | Implemented a new triage system required knowledge of implementation, hard work and close follow-up; the quality of the end product depends on a thorough planning and implementation process |
| Keeping spirits high and perseverance3 | Provided support to the key project workers, ensuring efforts all the way, including perseverance | Kept the spirits high to be positive, inclusive and patient throughout the project; the value of perseverance, realising that it is not just about introducing a new paper form, everyone will follow from tomorrow; it takes time and resources to introduce new routines |
| Networking and sustainability1 | Provided arenas for exchange of experience, knowledge, sustainability and further improvements | Established a regional network group gave the opportunity to sustain and improve SATS-N, but it also led to closer and better cooperation and collaboration in other areas in emergency medicine |
IHI, Institute for Healthcare Improvement; PDSA, plan–do–study–act; QI, quality improvement.