Blood sampling during nurse triage reduces patient length of stay in the emergency department: A propensity score-weighted, population-based study

Zaboli, Arian; Pfeifer, Norbert; Solazzo, Pasquale; Marsoner, Tania; Scola, Giulia; Malloth, Martina; Toccolini, Elia; Ciccariello, Laura; Magnarelli, Gabriele; Turcato, Gianni

doi:10.1016/j.ienj.2019.100826

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…46 Strategies to reduce ED testing turnaround times including point-of-care testing (at triage or bedside), ED-based satellite laboratories, and "stat," ED-dedicated laboratory and radiology services. 37,38,[47][48][49] Costs and benefits of these alternative strategies should be compared against those of PIT.…”

Section: Improving Test Turnaround Timesmentioning

confidence: 99%

Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

Franklin

Somand

et al. 2021

JACEP Open

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Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub‐optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs—which typically involve, at a minimum, a physician or advanced practice provider conducting an initial screening exam and potentially initiating treatment and diagnostic testing at the time of triage—are frequently endorsed as a mechanism to reduce ED length of stay (LOS) and therefore mitigate crowding, improve patient satisfaction, and improve ED operational and financial performance. However, the peer‐reviewed evidence regarding the impact of PIT programs on measures including ED LOS, wait times, and costs (as variously defined) is mixed. Mechanistically, PIT programs exert their effects by initiating diagnostic work‐ups earlier and, sometimes, by equipping triage providers to directly disposition patients. However, depending on local contextual factors—including the co‐existence of other front‐end interventions and delays in ED throughput not addressed by PIT—we demonstrate how these features may or may not ultimately translate into reduced ED LOS in different settings. Consequently, site‐specific analysis of the root causes of excessive ED LOS, along with mechanistic assessment of potential countermeasures, is essential for appropriate deployment and successful design of PIT programs at individual EDs. Additional motivations for implementing PIT programs may include their potential to enhance patient safety, patient satisfaction, and team dynamics. In this conceptual article, we address a gap in the literature by demonstrating the mechanisms underlying PIT program results and providing a framework for ED decision‐makers to assess the local rationale for, operational feasibility of, and financial impact of PIT programs.

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Section: Improving Test Turnaround Timesmentioning

confidence: 99%

Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

Franklin

Somand

et al. 2021

JACEP Open

View full text Add to dashboard Cite

show abstract

“…Blood tests are often requested indiscriminately in the Emergency department (ED) and many EDs have preset orders that are usually performed during triage before performing clinical assessment to improve the flow of patients through the department [ 1 ]. Conducting such tests might expedite patient care and reduce waiting time in the ED.…”

Section: Introductionmentioning

confidence: 99%

Are We Overusing Coagulation Studies in the Emergency Department?

Alyahya,

Alalshaikh,

Alkhulaif

et al. 2024

Emergency Medicine International

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Background and Objectives. Blood tests are often indiscriminately requested in the Emergency department (ED) and many EDs have preset orders that are usually performed at triage before clinical assessment to improve the flow of patients through the department. We conducted this study to evaluate the frequency of requests for coagulation profile, the incidence of abnormal coagulation profiles and the unnecessary use of coagulation profile testing in our institution. Methods. This retrospective observational study, conducted in the ED of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia, during July and August of 2021(2 months) examined coagulation profile requests. Patients’ demographic data (age and gender), medical and clinical history (presenting complaint, comorbidities, and diagnosis), the use of antiplatelets or anticoagulant agents and laboratory values for PT, APTT, and INR were collected. We calculated the total cost of unnecessary coagulation profile testing based on the independent assessment of two ED consultants. Results. Of 1,754 patients included in the study, 811 (46.2%) were males and 943 (53.8%) were females, with a mean age of 42.1 ± 18.5 years. There were 29 (1.7%) patients with liver disease and 21 (1.2%) patients had thromboembolic disease. The majority of the patients’ results were within normal levels of PT (n = 1,409, 80.3%), APTT (n = 1,262, 71.9%), and INR (n = 1,711, 97.4%). Evidence of active bleeding was detected in 29 patients (1.7%). Among patients with bleeding only one had an abnormal INR (3.01) and was on warfarin. Forty-six (2.6%) patients had elevated INR level. Cohen’s kappa between the two consultants was recorded at 0.681 (substantial agreement) in their assessment of the appropriateness of coagulation tests requests and both consultants believed that 1,051 tests (59.9%) were not indicated and were unnecessary. The expected annual cost saving if the unnecessary tests were removed would be around SAR 1,897,200 (approximately US$ 503,232) which is about SAR 180000 (US$ 48000)/1000 patients. Conclusion. This study showed that coagulation tests are overused in the ED. More than half of coagulation profile tests in our study population were deemed unnecessary and associated with significant cost. Targeted testing based on specific patient presentation and medical history can guide physicians in wisely choosing who needs coagulation studies.

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The preanalytical process in the emergency department, a European survey

Riesgo

Lauwaert

Cadamuro

et al. 2022

Clinical Chemistry and Laboratory Medicine (CCLM)

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Objectives Clinical decision-making in emergency medicine is under constant pressure from demand and performance requirements, with blood tests being a fundamental part of this. However, the preanalytical process has received little attention. Therefore, this study aimed to investigate the quality of preanalytical phase processes in European emergency departments (EDs) from the perspectives of the three main providers: clinicians, nurses, and laboratory specialists. Methods This online survey, distributed among European EDs and laboratories, was supported by the European Society for Emergency Nursing (EUSEN), European Society for Emergency Medicine (EuSEM), and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). The size of the centres, the European region, the responder’s profession and the country’s economic condition were used as co-variables. Results We included 376 responses from all ED-related professions from 306 European centres. In 66.9% of all ED visits, at least one blood test was performed. Tests were requested mostly by nurses (44.6%) using electronic Order/Entry systems (65.4%). Only a minority (19%) reported not using laboratory quality indicators (QIs). Most responders defined the TAT starting point “when the laboratory receives the sample” (66.1%), defining the goal to be “less than 60 min” (69.9%), but only 42.4% of the centres estimated achieving this goal. Conclusions Our survey illustrates the current situation on preanalytical blood sample processing in European EDs from the clinical and laboratory perspectives. The results emphasise the importance of the IT infrastructure and QI usage in this process and highlight some differences between European regions.

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Blood sampling during nurse triage reduces patient length of stay in the emergency department: A propensity score-weighted, population-based study

Cited by 3 publications

References 23 publications

Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

Are We Overusing Coagulation Studies in the Emergency Department?

The preanalytical process in the emergency department, a European survey

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