Perceived impact of physician-in-triage on resident education

Ullo, Michael; Alexander, Andreia B.; Sugalski, Gregory

doi:10.1016/j.ajem.2018.11.036

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…• Graduate medical education: while serving as a triage provider might confer new learning opportunities to residents, in cases where residents do not work in triage, PIT programs might reduce opportunities for residents to formulate their own assessments and plans. 64,65 • Medicolegal considerations: PIT may introduce medicolegal considerations related to screening exam adequacy. 34 Further literature elucidating these considerations would help inform PIT program design and potentially enhance providers' buy-in.…”

Section: Limitations Of Literature and Other Important Considerationsmentioning

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: Limitations Of Literature and Other Important Considerationsmentioning

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

“…[1] Another study looked to see if there was a perceived impact on competencies again with no impact detected. [2] We chose to see if there was a quantitative difference to support this feeling felt by some but not qualitatively detected.…”

mentioning

confidence: 99%