The effect of physician triage on emergency department length of stay.
BACKGROUND
Emergency Department (ED) overcrowding is a serious public health issue, but few solutions exist.


OBJECTIVE
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.


CONCLUSIONS
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.
Han
Jin H
JH
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4700, USA.
France
Daniel J
DJ
Levin
Scott R
SR
Jones
Ian D
ID
Storrow
Alan B
AB
Aronsky
Dominik
D
D000046:Academic Medical Centers; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D012189:Retrospective Studies; D014193:Trauma Centers; D014218:Triage / Q000379:methods*