Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trial.
BACKGROUND
Triage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear.


OBJECTIVE
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 AM 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.
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Brian R
BR
Holroyd
Michael J
MJ
Bullard
Karen
K
Latoszek
Debbie
D
Gordon
Sheri
S
Allen
Siulin
S
Tam
Sandra
S
Blitz
Philip
P
Yoon
Brian H
BH
Rowe
D000328:Adult; D000368:Aged; D000416:Alberta; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011336:Probability; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D017749:Total Quality Management; D014218:Triage