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Brian R. Holroyd MD Michael J. Bullard MD Karen Latoszek RN Debbie Gordon BScN MBA Sheri Allen BScN Siulin Tam BSc MSc MBA Sandra Blitz MSc Philip Yoon MD CCFP MBA Brian H. Rowe MD MSc CCFP 《Academic emergency medicine》2007,14(8):702-708
Background Triage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear.
Objectives To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting.
Methods A six-week TLP clinical research project was conducted between December 9, 2005, and February 9, 2006. A TLP was deployed for nine hours (11am to 8 pm ) daily to initiate patient management, assist triage nurses, answer all medical consult or transfer calls, and manage ED administrative matters. The study was divided into three two-week blocks; within each block, seven days were randomized to TLP shifts and the other seven to control shifts. Outcomes included patient length of stay, proportion of patients who left without complete assessment, staff satisfaction, and episodes of ambulance diversion.
Results TLPs assessed a median of 14 patients per shift (interquartile range, 13–17), received 15 telephone calls per shift (interquartile range, 14–20), and spent 17–81 minutes per shift consulting on the telephone. The number of patients and their age, gender, and triage score during the TLP and control shifts were similar. Overall, length of stay was decreased by 36 minutes compared with control days (4:21 vs. 4:57; p = 0.001). Left without complete assessment cases decreased from 6.6% to 5.4% (a 20% relative decrease) during the TLP coverage. The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days.
Conclusions A TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs. 相似文献
Objectives To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting.
Methods A six-week TLP clinical research project was conducted between December 9, 2005, and February 9, 2006. A TLP was deployed for nine hours (11
Results TLPs assessed a median of 14 patients per shift (interquartile range, 13–17), received 15 telephone calls per shift (interquartile range, 14–20), and spent 17–81 minutes per shift consulting on the telephone. The number of patients and their age, gender, and triage score during the TLP and control shifts were similar. Overall, length of stay was decreased by 36 minutes compared with control days (4:21 vs. 4:57; p = 0.001). Left without complete assessment cases decreased from 6.6% to 5.4% (a 20% relative decrease) during the TLP coverage. The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days.
Conclusions A TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs. 相似文献
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Barbara RN MSN MPH APN CEN Tracey MD FACEP Rosey RN BSN 《Journal of emergency nursing》2006,32(6):502-505
The majority of emergency departments in the US experience overcrowding. This trend is likely to continue due to multiple economic stressors, use of the emergency department as a healthcare safety net, and other factors.Process improvements in the emergency department are best effected when resources are committed to 1 of 3 areas typically responsible for bottlenecks: triage, tests and treatments, or patient discharge/admission. We described one solution that dramatically affected the triage process, improved our ability to respond to increasing patient volume, and enabled revenue recovery through a decrease in our LWBS rate (Figure). Establishment of Unit 45 has improved satisfaction and morale on the part of the staff, the hospital, and most importantly, the patients. Because of cooperative teamwork and “out-of-the-box” thinking, we were able to create a highly acceptable solution to a frustrating situation and maintain our focus of providing the best patient care possible. 相似文献
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Irina Svirsky Lisa R. Stoneking Kristi Grall Matthew Berkman Uwe Stolz Farshad Shirazi 《The Journal of emergency medicine》2013
Background
Emergency Department (ED) overcrowding is a national problem. Initiating orders in triage has been shown to decrease length of stay (LOS), however, nurse, physician assistant, and attending physician advanced triage have all been criticized.Study Objectives
Our primary objective was to show that Emergency Medicine resident-initiated advanced triage shortens patient LOS. Our secondary objective was to evaluate whether or not resident triage decreases the number of patients who left prior to medical screening (LPTMS).Methods
This prospective interventional study was performed in a 42-bed, Level III trauma center, academic ED in the United States, with an annual census of approximately 41,000 patients. A junior or senior Emergency Medicine resident initiated orders on 16 weekdays for 6 h daily on patients presenting to triage. Patients evaluated during the 6-h period on other weekdays served as the control. The study was powered to detect a reduction in LOS of 45 min. Multivariable median regression was used to compare length of stay and Fisher’s exact test to compare proportions.Results
There were 1346 patients evaluated in the ED during the intervention time. Regression analysis showed a 37-min decrease in median LOS for patients on intervention days as compared to control days (p = 0.02). The proportion of patients who LPTMS was not statistically different (p = 0.7) for intervention days (96/1346, 7.13%) compared to control days (136/1810, 7.51%).Conclusions
Resident-initiated advanced triage is an effective method to decrease patient LOS, however, our effect size is smaller than predicted and did not significantly affect the percent of patients leaving before medical screening. 相似文献4.
Jin H. Han Daniel J. France Scott R. Levin Ian D. Jones Alan B. Storrow Dominik Aronsky 《The Journal of emergency medicine》2010
Background: Emergency Department (ED) overcrowding is a serious public health issue, but few solutions exist. Objectives: We sought to determine the impact of physician triage on ED length of stay for discharged and admitted patients, left-without-being-seen (LWBS) rates, and ambulance diversion. Methods: This was a pre-post study performed using retrospective data at an urban, academic tertiary care, Level I trauma center. On July 11, 2005, physician triage was initiated from 1:00 p.m. to 9:00 p.m., 7 days a week. An additional physician was placed in triage so that the ED diagnostic evaluation and treatment could be started in waiting room patients. Using the hospital information system, we obtained individual patient data, ED and waiting room statistics, and diversion status data from a 9-week pre-physician triage (May 11, 2005 to July 10, 2005) and a 9-week physician triage (July 11, 2005 to September 9, 2005) period. Results: We observed that overall ED length of stay decreased by 11 min, but this decrease was entirely attributed to non-admitted patients. No difference in ED length of stay was observed in admitted patients. LWBS rates decreased from 4.5% to 2.5%. Total time spent on ambulance diversion decreased from 5.6 days per month to 3.2 days per month. Conclusion: Physician triage was associated with a decrease in LWBS rates, and time spent on ambulance diversion. However, its effect on ED LOS was modest in non-admitted ED patients and negligible in admitted patients. 相似文献
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Objective: To evaluate the effect of altering pediatric triage criteria on ED triage scoring and patient flow.
Methods: A prospective observational study of a pediatric triage modification was performed. Data for all pediatric patients presenting to an urban general ED during a six-month study period were collected. After the first three months, pediatric triage criteria were altered by elevating the acuity of several historical items and specifically listing abnormal signs and symptoms. Outcome measures included triage score assignment, criteria making the patient emergent, proportion of emergent or urgent triage assignments, and times to examination, disposition, and admission.
Results: Altering pediatric triage criteria resulted in a significant (p < 0.05) increase in the number of patients triaged as emergent (2% vs 15%) or urgent (48% vs 55%). In addition, for emergent and urgent patients there was a significant decrease (p < 0.05) in the mean times to ED examination (50 vs 44 min), floor admission (355 vs 245 min), and intensive care unit admission (221 vs 132 min). The triage changes that had a significant impact on these results were a history of color change, decreased activity, and prematurity with complications.
Conclusions: A significant improvement in pediatric patient flow occurred after posting age-specific abnormal signs and symptoms as well as elevating triage acuity for specific historical clues. 相似文献
Methods: A prospective observational study of a pediatric triage modification was performed. Data for all pediatric patients presenting to an urban general ED during a six-month study period were collected. After the first three months, pediatric triage criteria were altered by elevating the acuity of several historical items and specifically listing abnormal signs and symptoms. Outcome measures included triage score assignment, criteria making the patient emergent, proportion of emergent or urgent triage assignments, and times to examination, disposition, and admission.
Results: Altering pediatric triage criteria resulted in a significant (p < 0.05) increase in the number of patients triaged as emergent (2% vs 15%) or urgent (48% vs 55%). In addition, for emergent and urgent patients there was a significant decrease (p < 0.05) in the mean times to ED examination (50 vs 44 min), floor admission (355 vs 245 min), and intensive care unit admission (221 vs 132 min). The triage changes that had a significant impact on these results were a history of color change, decreased activity, and prematurity with complications.
Conclusions: A significant improvement in pediatric patient flow occurred after posting age-specific abnormal signs and symptoms as well as elevating triage acuity for specific historical clues. 相似文献
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C. Keith Stone MD J. Stephan Stapczynski MD Stephen H. Thomas MD Shaheed I. Koury MD 《Academic emergency medicine》1996,3(2):153-156
Objective: To quantify the number of patients seen per hour by non–emergency medicine (non–EM) residents in a university hospital ED.
Methods: This retrospective observational study was performed in a university hospital ED and level I trauma center. The facility had no EM residency, but was staffed with 24–hour EM faculty coverage. A computerized tracking system was searched for the number of patients seen by each of 93 non–EM residents for 12 nonconsecutive months. The ED schedule for each month was used to calculate the number of hours worked by each resident. From these figures, the number of patients seen per hour by each resident was calculated.
Results: The postgraduate years of training of the residents were as follows: 78 (84%) were PGY1, ten (11%) were PGY2, and five (5%) were PGY3. All the residents combined saw a mean 0. 95 ± 0. 20 patients/ hour, with a range from 0. 58 to 1. 75 patients/hour. There was no significant difference between the numbers of patients seen when compared by specialty using the Tukey–Kramer test (α = 0. 05).
Conclusion: The rate at which non–EM residents work up patients is consistent with previously reported rates for EM residents. 相似文献
Methods: This retrospective observational study was performed in a university hospital ED and level I trauma center. The facility had no EM residency, but was staffed with 24–hour EM faculty coverage. A computerized tracking system was searched for the number of patients seen by each of 93 non–EM residents for 12 nonconsecutive months. The ED schedule for each month was used to calculate the number of hours worked by each resident. From these figures, the number of patients seen per hour by each resident was calculated.
Results: The postgraduate years of training of the residents were as follows: 78 (84%) were PGY1, ten (11%) were PGY2, and five (5%) were PGY3. All the residents combined saw a mean 0. 95 ± 0. 20 patients/ hour, with a range from 0. 58 to 1. 75 patients/hour. There was no significant difference between the numbers of patients seen when compared by specialty using the Tukey–Kramer test (α = 0. 05).
Conclusion: The rate at which non–EM residents work up patients is consistent with previously reported rates for EM residents. 相似文献
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Joseph M. Geskey Glenn Geeting Cheri West Christopher S. Hollenbeak 《The Journal of emergency medicine》2013
Background
Physician consultation in the Emergency Department (ED) can account for a significant portion of ED length of stay, which can lead to poor clinical outcomes.Objective
The purpose of this study was to determine whether an institutional guideline could lead to a reduction in time between consult request and admission decision. This guideline codified a 90-min expected time interval to arrive and complete an admission disposition where the consulting and admitting service were the same in an academic ED with weekly audits and reports to departmental chairs and hospital administrators.Methods
This was a study of consultation times of patients who presented to an academic ED 6 months before the adoption of an institutional guideline and 6 months after the adoption of the guideline. Data measurement in both periods included the length of time from ED consult order to admission disposition, time of ED discharge, number of ED consultations (single and multiple), ED admissions, and the hospital discharge time of admitted patients.Results
Physician consult response time decreased from 121 min to 100 min (p < 0.0001), and patients left the ED 18 min earlier (p = 0.0221) after implementation of the consultation guideline despite more ED visits, consultations, and admissions in the post-implementation time period. Patients were discharged from the inpatient setting 50 min later (p < 0.0001) after implementation of the guideline.Conclusion
An institutional guideline codifying timely ED consultations led to a significant reduction in the time from ED consultation to admission disposition while also allowing patients to leave the ED earlier in a high-occupancy academic medical center. However, the discharge time of admitted hospital patients was later after implementation of the guideline. 相似文献13.
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Robert M. Rodriguez MD Graham M. Dresden Justin C. Young 《Academic emergency medicine》2001,8(7):740-745
One of the most successful reality-based television shows is The Learning Channel's "Trauma-Life in the ER," in which patients are filmed prior to being consented and camera crews are intimately intertwined in resuscitations. OBJECTIVE: To assess provider and patient attitudes regarding privacy and satisfaction during filming. METHODS: This was a prospective survey of patients and providers working in an urban, county teaching emergency department (ED). Scores of visual analog scales (VASs) for satisfaction, privacy, and willingness to return to the ED were accessed. RESULTS: Eighty patients, 39 physicians and 39 nurses, were interviewed. On a 10-cm VAS where 0 = no invasion of patient privacy and 10 = extreme privacy invasion, the mean (+/-SD) rating by physicians was 5.4 (+/-2.6), by nurses was 4.9 (+/-3.1), and by patients was 2.3 (+/-3.2). There was no significant difference between physician and nurse ratings (p = 0.69), but patients rated invasion of privacy significantly lower (p < 0.0001). Filmed patients rated significantly higher invasion of privacy (3.8 +/- 4.1) than patients not filmed or those unsure whether they had been filmed (1.6 +/- 2.5); p < 0.01). On a 10-cm VAS where -5 = extreme decrease in satisfaction and 5 = extreme increase in satisfaction, the mean rating by physicians was -0.25 (+/-1.6), by nurses was -0.32 (+/-1.3), and by patients was 0.02 (+/-1.4). There was no statistical difference between the satisfaction levels of providers and patients (p = 0.19). CONCLUSIONS: Providers rated invasion of patient privacy higher than patients rated their own invasion of privacy. Patients who were filmed rated invasion of privacy higher than patients who were not filmed. Filming had no significant effect on the satisfaction of providers or patients. 相似文献
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《The Journal of emergency medicine》2023,64(1):77-82
BackgroundHospitals have implemented innovative strategies to address overcrowding by optimizing patient flow through the emergency department (ED). Vertical split flow refers to the concept of assigning patients to vertical chairs instead of horizontal beds based on patient acuity.ObjectiveEvaluate the impact of vertical split flow implementation on ED Emergency Severity Index (ESI) level 3, patient length of stay, and throughput at a community hospital.MethodsRetrospective cohort study of all ESI level 3 patients presenting to a community hospital ED over a 3-month period prior to and after vertical split flow implementation between 2018 and 2019.ResultsIn total, data were collected from 10,638 patient visits: 5262 and 5376 patient visits pre- and postintervention, respectively. There was a significant reduction in mean overall length of stay when ESI-3 patients were triaged with vertical split flow (251 min vs 283 min, p < 0.001).ConclusionsCommunity hospital ED implementation of vertical split flow for ESI level 3 patients was associated with a significant reduction in overall length of stay and improved throughput. This model provides a solution to increase the number of patients that can be simultaneously cared for in the ED without increasing staffing or physical space. 相似文献
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