Hospitalists as Triagists: Description of the Triagist Role across Academic Medical Centers

Abstract

From the hospitalist perspective, triaging involves the evaluation of a patient for potential admission to an inpatient service. Although traditionally done by residents, many academic hospitalist groups have assumed the responsibility for triaging. We conducted a cross-sectional survey of 235 adult hospitalists at 10 academic medical centers (AMCs) to describe the similarities and differences in the triagist role and assess the activities and skills associated with the role. Eight AMCs have a defined triagist role; at the others, hospitalists supervise residents/advanced practice providers. The triagist role is generally filled by a faculty physician and shared by all hospitalists. We found significant variability in verbal communication practices (P = .02) and electronic communication practices (P < .0001) between the triagist and the current provider (eg, emergency department, clinic provider), and in the percentage of patients evaluated in person (P < .0001). Communication skills, personal efficiency, and systems knowledge are dominant themes of attributes of an effective triagist.

Triaging Admissions: A Survey of Internal Medicine Resident Experiences and Perceptions and Recommendations on Inpatient Triage Education

“…Mastering these skills is increasingly important, as the triage physician role has become increasingly common. 5,6,14 While the majority of PGY-3s and PGY-4s reported feeling adequately trained for triaging activities, they also felt increasing anxiety about the role, which suggests gaps in their educational experience. We hypothesize that these gaps are in 2 areas.…”

“…In contrast, triaging skills require operating at the intersection of multiple clinical services and understanding capabilities/ limitations of each local system as well as practices around admissions. 5 This implicit knowledge could inform a triagist-specific curriculum, and could be mapped to System-Based Practice 3: Physicians Role in the Health Care System−Level 2: "Describe how components of a complex health care system are interrelated, and how this impacts patient care." 13 The second potential gap encompasses collaborative conflict management and negotiation skills, specifically, the subcompetency of "Interpersonal and Communication Skills 2: Interprofessional and Team Communication."…”

“…With the increasing complexity of health care systems and separation of the outpatient and inpatient settings, this transition is generally managed by an inpatient physician/hospitalist or a "triagist." [5][6][7] The increased complexity and siloing of clinicians is even more pronounced in medical schools and teaching hospitals, 8 which typically care for the most complex patients, whose care requires diagnostic and therapeutic services not readily available throughout the community. 8 The presence of learners who rotate between services also contributes to care discontinuities.…”

“…9 For medical patients, assessing patients for admission had traditionally been done by the on-call internal medicine resident; however, this function is now increasingly performed by faculty physicians or dedicated triagists. 5 Several factors have influenced this shift: the growth of hospital medicine, changes to residency such as duty hour restrictions, increased attention on admission appropriateness, and efficiency of patient flow.…”

Qualitative analysis of disposition decision making for patients referred for admission from the emergency department without definite medical acuity

“…Additionally, most of the current literature focuses on ED physician perspective even as internal medicine trained hospitalists increasingly serve in the role of 'triage physician' providing an inpatient-based acute care screening and approval for admissions. 30 31 We propose that hospitalists can provide a useful vantage point from which to learn more about this phenomenon.…”