title: Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department.
abstract: BACKGROUND
  Emergency Department (ED) crowding is well recognized, and multiple studies have demonstrated its negative effect on patient care.
  
  
  OBJECTIVE
  This study aimed to assess the effect of an intervention, Supplemented Triage and Rapid Treatment (START), on standard ED performance measures. The START program complemented standard ED triage with a team of clinicians who initiated the diagnostic work-up and selectively accelerated disposition in a subset of patients.
  
  
  METHODS
  This retrospective before-after study compared performance measures over two 3-month periods (September-November 2007 and 2008) in an urban, academic tertiary care ED. Data from an electronic patient tracking system were queried over 12,936 patients pre-intervention, and 14,220 patients post-intervention. Primary outcomes included: 1) overall length of stay (LOS), 2) LOS for discharged and admitted patients, and 3) the percentage of patients who left without complete assessment (LWCA).
  
  
  RESULTS
  In the post-intervention period, patient volume increased 9% and boarder hours decreased by 1.3%. Median overall ED LOS decreased by 29 min (8%, 361 min pre-intervention, 332 min post-intervention; p < 0.001). Median LOS for discharged patients decreased by 23 min (7%, 318 min pre-intervention, 295 min post-intervention; p < 0.001), and by 31 min (7%, 431 min pre-intervention, 400 min post-intervention) for admitted patients. LWCA was decreased by 1.7% (4.1% pre-intervention, 2.4% post-intervention; p < 0.001).
  
  
  CONCLUSIONS
  In this study, a comprehensive screening and clinical care program was associated with a significant decrease in overall ED LOS, LOS for discharged and admitted patients, and rate of LWCA, despite an increase in ED patient volume.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: White
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
authors.forename: Julia
authors.initials: J
authors.lastname: Sinclair
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Sarah
authors.initials: S
authors.lastname: Carignan
authors.forename: Joyce
authors.initials: J
authors.lastname: McIntyre
authors.forename: Paul D
authors.initials: PD
authors.lastname: Biddinger
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration* / Q000706:statistics & numerical data