Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

Abstract

Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17th 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8–66.6) to 10.2 (5.7–18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2–84.7) to 10.5 (5.9–18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1–5.3) to 3.7 (2.3–5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8–1.8) to 0.3 (0.2–0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology, anticipating that it may be better for the downstream physician to have more information rather than less.

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

“…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 . Although this study on swarming was not designed to quantify an improvement in efficiency metrics, our findings showed an average time commitment of approximately 10 minutes for the physicians, suggesting that a substantial amount can be accomplished in regard to patient care, communication, and education in a relatively short time frame.…”

“…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 . In the swarming model, the team responsible for the initial assessment is the primary care team for the patient.…”

Older adults are prioritized in terms of waiting time under the emergency triage system in Guangzhou, China

“…Waiting time represents the services that an ED can provide, and is one of the measurable key performance indicators in hospitals. 28 However, research on emergency waiting time in China is scarce. Comparing absolute waiting time between patients is difficult to interpret because of the difference in severity.…”

Descripción de las características del fenómeno Crowding en la Central de Emergencia de Adultos, en un hospital universitario de alta complejidad: estudio de cohorte retrospectiva

“…La medición horaria de Crowding a través de la escala de NEDOCS aporta información irremplazable para la toma de decisiones. Las centrales de emergencias están tratando de aliviar el Crowding mediante diversas intervenciones 14,15 . En un futuro, la potencial generación de un sistema que permitiera la medición en tiempo real del grado de Crowding en la CE, podría brinda una herramienta irremplazable para la gestión y por ende, para la seguridad de los pacientes 16 .…”