Placing physician orders at triage: the effect on length of stay.
OBJECTIVE
Emergency department (ED) crowding is a significant problem nationwide, and numerous strategies have been explored to decrease length of stay. Placing a physician in the triage area to rapidly disposition low-acuity patients and begin evaluations on more complex patients is one strategy that can be used to lessen the effect of ED crowding. The goal of this study is to assess the effect of order placement by a triage physician on length of stay for patients ultimately treated in a bed within the ED.


METHODS
We conducted a pre-experimental study with retrospective data to evaluate patients with and without triage physician orders at a single academic institution. A matched comparison was performed by pairing patients with the same orders and similar propensity scores. Propensity scores were calculated with demographic and triage data, chief complaint, and ED capacity on the patient's arrival.


RESULTS
During the 23-month study period, a total of 66,909 patients were sent to the waiting room after triage but still eventually spent time in an ED bed. A quarter of these patients (23%) had physician orders placed at triage. After a matched comparison, patients with triage orders had a 37-minute (95% confidence interval 34 to 40 minutes) median decrease in time spent in an ED bed, with an 11-minute (95% confidence interval 7 to 15 minutes) overall median increase in time until disposition.


CONCLUSIONS
Our study suggests that early orders placed by a triage physician have an effect on ED operations by reducing the amount of time patients spend occupying an ED bed.
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-4700, USA. stephan.russ@vanderbilt.edu
Stephan
S
Russ
Ian
I
Jones
Dominik
D
Aronsky
Robert S
RS
Dittus
Corey M
CM
Slovis
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D010820:Physicians; D057216:Propensity Score; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage / Q000706:statistics & numerical data*