Improved quality and efficiency after the introduction of physician-led team triage in an emergency department

Abstract

BackgroundOvercrowding in the emergency department (ED) may negatively affect patient outcomes, so different triage models have been introduced to improve performance. Physician-led team triage obtains better results than other triage models. We compared efficiency and quality measures before and after reorganization of the triage model in the ED at our county hospital.Materials and methodsWe retrospectively compared two study periods with different triage models: nurse triage in 2008 (baseline) and physician-led team triage in 2012 (follow-up). Physician-led team triage was in use during day-time and early evenings on weekdays. Data were collected from electronic medical charts and the National Mortality Register.ResultsWe included 20,073 attendances in 2008 and 23,765 in 2012. The time from registration to physician presentation decreased from 80 to 33 min (P < 0.001), and the length of stay decreased from 219 to 185 min (P < 0.001) from 2008 to 2012, respectively. All of the quality variables differed significantly between the two periods, with better results in 2012. The odds ratio for patients who left before being seen or before treatment was completed was 0.62 (95% confidence interval 0.54–0.72). The corresponding result for unscheduled returns was 0.36 (0.32–0.40), and for the mortality rates within 7 and 30 days 0.72 (0.59–0.88) and 0.84 (0.73–0.97), respectively. The admission rate was 37% at baseline and 32% at follow-up (P < 0.001).ConclusionPhysician-led team triage improved the efficiency and quality in EDs.

Defining “Swarming” as a New Model to Optimize Efficiency and Education in an Academic Emergency Department

“…Our results also showed a consensus amongst team members that swarming increased efficiency compared to the traditional serial model of care. A number of studies show increased efficiency with changes in front‐end operations, mostly focusing on rapid triage and physician/provider in triage . At the same time, a systematic review showed no statistically significant decrease in LOS with team triage, and other studies show improvements only with certain patient acuity levels .…”

“…Several differences exist between the swarming model and front‐end operational interventions. In many of the physician‐in‐triage or team triage models, the team that performs the initial assessment is typically not the definitive treatment team . When one provider sees a patient in triage, with a different provider for the remainder of the ED stay, this increases hand‐offs and may also increase the diagnostic studies ordered by the initial triage provider .…”

The busyness of medicine

“…Our patient encounters are not formulaic of history followed by examination, then investigation; they are often in complete reverse, with treatment commenced immediately upon receiving a patient – aspirin for chest pain just one example. The concept of medical or multidisciplinary triage seeks to frontload decisions and care in order to optimise a patient's outcome and expedite later definitive disposition . This subversion of the tenets of traditional medical teaching puts us at odds with other specialties who often expect a level of historical or clinical detail that we feel will not influence a patient's immediate care or destination.…”

Fast Feedback? Managing vulnerability in Emergency Departments through continuous improvement

“…Burnström et ál. stated that physician-led team triage resulted in a reduction in the wait time for a physician, shorter length of stay and decreases in mortality rates after 7 and 30 days from their ED departure 8 .…”