Background: Because abnormal vital signs indicate the potential for clinical deterioration, it is logical to make emergency physicians immediately aware of those patients who present with abnormal vital signs. Objectives: To determine if a clinical triggers program in the emergency department (ED) setting that utilized predetermined abnormal vital signs to activate a rapid assessment by an emergency physician-led multidisciplinary team had a measurable effect on inpatient hospital metrics. Methods: The study design was a retrospective pre and post intervention study. The intervention was the implementation of an ED clinical "triggers" program. Abnormal vital sign criteria that warranted a trigger response included: heart rate <40 beats/minute or >130 beats/minutes, respiratory rate <8 breaths/minute or >30 breaths/minute, systolic blood pressure <90 mm Hg, or oxygen saturation <90% on room air. The primary outcome investigated was the median days admitted with secondary outcomes of median days in special care unit, in-hospital 30-day mortality and proportion of patients who required an upgrade in inpatient care level. Results: There was no difference in median days admitted for inpatient care (3.8 v. 4.0 days, p = 0.21) or median days spent in a special care unit (5.0 v. 5.6 days, p = 0.42) between the groups. There was no difference in the percentage of in-hospital patient deaths (6.0% v. 5.6%, p = 0.66) or frequency of upgrade in level of care within 24 hours (4.9% v. 4.0%, p = 0.52). Conclusions: In our study, the implementation of an ED clinical triggers program did not result in a significant change in measured inpatient outcomes.
Background: The physician in triage (PIT) model has been proposed as a process improvement to help increase efficiency in the Emergency Department setting. However, its effect on patient satisfaction has not been well established.Methods: An interventional study comparing patient satisfaction scores for the 6-month period before and after implementation of a physician in triage model. In our system an additional attending physician was assigned to triage from 1 p.m. to 9 p.m. daily. Outcome measures were mean scores obtained from respondents to Press Ganey® patient satisfaction surveys for selected questions most likely to be impacted by PIT implementation and those included in the physician section of the survey.Results: Five hundred and eight respondents seen in the six months before the initiation of the PIT team and 458 respondents in the six months after the system change were included in the study. Improvement was noted in the absolute Press Ganey® scores in the Post-PIT time period across all questions analyzed with statistically significant differences noted for 8 of the 10 questions studied.
Conclusions:Although seemingly small there was a statistically significant improvement in the absolute patient satisfaction scores after adding a physician in triage. Because small gains in absolute scores can result in large improvements on the percentile rank when using Press Ganey® surveys, physician in triage may be of significant benefit to overall patient satisfaction.
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