title: Avoiding prolonged waiting time during busy periods in the emergency department: Is there a role for the senior emergency physician in triage?
abstract: OBJECTIVE
  Patient satisfaction at emergency departments can be improved by reductions in waiting time. Traditional methods require registration and triage before seeing the doctor with senior emergency physicians mainly engaged in treating serious cases. We examine a radical change in workflow pattern on waiting time by placing a senior emergency physician with the triage nurse and examining the impact of treating simple cases upfront with discharge on the waiting times for stretcher cases.
  
  
  METHODS
  A senior emergency physician was placed with the triage nurse in the Department of Emergency Medicine at Alexandra Hospital during peak busy periods of patient attendance over a period of 2 months. Measures were made of waiting time (registration to doctor consult) of PACS 3 and PACS 2 (Patient Acvity Score) cases accordingly.
  
  
  RESULTS
  Ten days were chosen for the changed workflow practice and 10 days for controls in which normal traditional working practice followed. On all days, there was the same number of medical staff. The average waiting time for walk-in patients (PACS 3) was 19 min on experimental days as compared with 35.5 min on control days, with 78% being seen within 30 min in the experimental group compared with 48% on control days (P < 0.05). The PACS 2 waiting time was also significantly decreased on experimental days (P < 0.05).
  
  
  CONCLUSIONS
  Placing a senior emergency physician with the triage nurse reduced waiting times for walk-in cases. One third of attendances were treated and discharged quickly, allowing the consulting room and PACS 1/PACS 2 doctors to act more efficiently.
authors.affiliation: Department of Emergency Medicine, Alexandra Hospital, Singapore, Republic of Singapore. james_travers@alexhosp.com.sq
authors.forename: James P
authors.initials: JP
authors.lastname: Travers
authors.forename: Francis C Y
authors.initials: FC
authors.lastname: Lee
mesh_terms: D003299:Cooperative Behavior; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D004635:Emergency Medicine / Q000458:organization & administration; D016529:Emergency Nursing / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008505:Medical Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D017146:Models, Organizational; D024802:Nurse's Role; D010348:Patient Care Team / Q000458:organization & administration; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D010819:Physician's Role; D019555:Physician-Nurse Relations; D011446:Prospective Studies; D012846:Singapore; D011795:Surveys and Questionnaires; D013997:Time Factors; D013996:Time and Motion Studies; D014218:Triage / Q000458:organization & administration*; D014850:Waiting Lists