A first look that matters: Implementing a standardized pretriage nurse role across a regional health authority

Background: Across Canada, emergency departments are experiencing unprecedented overcrowding, with prolonged waits to triage linked to delayed recognition of critical illness, increased patient risk, and worsening outcomes. Interior Health is one of five publicly funded regional health authorities in British Columbia, serving a large, geographically diverse population through 29 emergency departments, many of which are rural. With approximately 530,000 emergency visits annually, prolonged waits to access triage have been an ongoing challenge, compounded by limited data regarding actual time to first clinical assessment at many sites. In 2025, the Interior Health Emergency Services Network formalized a standardized pretriage workflow to support early patient assessment and safety. Objectives: The objective of this initiative was to implement a standardized pretriage role staffed by a CTAStrained emergency department registered nurse (RN), responsible for providing a critical first look for patients upon arrival. Key objectives included rapid clinical assessment, preregistration, early identification of critically ill or highrisk patients, facilitation of patient flow, and strengthened collaboration with the triage nurse. Methods: Implementation: Increasing patient volumes and lineups at triage can delay initial assessment and prioritization. The pretriage role was introduced to provide an early clinical presence during periods of high volume or acuity, enhancing patient safety through timely recognition of critical presentations. Pretriage is not intended to replace formal triage and is not used when patients can be brought directly to the triage nurse without delay. Instead, it functions as a supportive process when access to triage is delayed and the target of triage within 10 minutes of arrival is challenged. Standardized role expectations, documentation processes, and decision supports were developed to promote consistency across diverse emergency department settings. Results: Initial informal evaluation demonstrates positive staff support for the pretriage process, improved role clarity, and streamlined documentation. Early feedback suggests enhanced early recognition of patient deterioration and improved flow during peak volumes. A formal evaluation is currently underway, including standardized data collection and a staff survey planned for February 2026, to further assess impact across a geographically dispersed health authority. Implications and lessons learned: Despite deliberate planning and stakeholder engagement, effective dissemination of information to frontline staff remains challenging, particularly across multiple sites with varying resources and workflows. This presentation will explore lessons learned related to change management, staff engagement, data collection, and evaluation in a large regional system. Attendees will gain practical insights into implementing and sustaining a standardized pretriage role that can be adapted to emergency departments across Canada.