Triad: A Novel Team Structure Pilot and its Impact on Patient Experience in the Pediatric Emergency Department

Introduction: Patient experience is inextricably tied to effective communication between the care team and patient. Published trials designed to improve communication and therefore patient experience in the pediatric emergency department setting are lacking. Methods: This is a novel care team reorganization in a single tertiary care pediatric emergency department. A Triad team consisted of a nurse, emergency technician (Tech), and physician or advanced practice practitioner (APP). The team was designed and trained with an emphasis on closed loop communication with the team and patient to test whether improving effective communication can subsequently improve the patient experience. Using a real-time survey, patient responses were compared among three groups: Pre-Intervention, Triad, and Non-Triad intervention. Results: Triad team survey responses were generally as good as or better than comparison Triad survey groups, especially on questions related to care team communication. Responses were found to be statistically significant (p < .05) for two questions: “How long ED care may take” and “Updates on delays in treatment”. The Triad survey was also compared to the standard institutional patient experience survey. Patients and families scored their experience much lower on these as compared to all Triad surveys. Conclusions: Reorganizing our teams had a clear impact on certain experience metrics and may serve as a basis for future efforts to improve patient experience through care team reorganization. It also highlighted the challenges of deviating from our ED’s standard team configuration.