title: The role of triage liaison physicians on mitigating overcrowding in emergency departments: a systematic review.
abstract: OBJECTIVE
  The objective was to examine the effectiveness of triage liaison physicians (TLPs) on mitigating the effects of emergency department (ED) overcrowding.
  
  
  METHODS
  Electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, HealthSTAR, Dissertation Abstracts, and ABI/INFORM Global), controlled trial registry websites, conference proceedings, study references, contact with experts in the field, and correspondence with authors were used to identify potentially relevant TLP studies. Intervention studies in which a TLP was used to influence ED overcrowding metrics (length of stay [LOS] in minutes, physician initial assessment [PIA], and left without being seen [LWBS]) were included in the review. Two reviewers independently conducted data extraction and assessed the citation relevance, inclusion, and study quality. For continuous outcomes, weighted mean differences (WMD) were calculated and reported with corresponding 95% confidence intervals (CIs). For dichotomous variables, individual and pooled statistics were calculated as relative risk (RR) with 95% CI.
  
  
  RESULTS
  From 14,446 potentially relevant studies, 28 were included in the systematic review. Thirteen were journal publications, 12 were abstracts, and three were Web-based articles. Most studies employed before-after designs; 23 of the 28 studies were considered of weak quality. Based on the statistical pooling of data from two randomized controlled trials (RCTs), TLP resulted in shorter ED LOS compared to nurse-led triage (WMD = -36.85 min; 95% CI = -51.11 to -22.58). One of these RCTs showed a significant reduction in the PIA associated to TLP presence (WMD = -30.00 min; 95% CI = -56.91 to -3.09); the other RCT showed no change in LWBS due to a CI that included unity (RR = 0.82; 95% CI = 0.67 to 1.00).
  
  
  CONCLUSIONS
  While the evidence summarized here suggests that to have a TLP is an effective intervention to mitigate the effects of ED overcrowding, due to the weak research methods identified, more research is required before its widespread implementation.
authors.affiliation: Department of Emergency Medicine, University of Alberta, Edmonton, Canada. brian.rowe@ualberta.ca
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Guo
authors.forename: Cristina
authors.initials: C
authors.lastname: Villa-Roel
authors.forename: Michael
authors.initials: M
authors.lastname: Schull
authors.forename: Brian
authors.initials: B
authors.lastname: Holroyd
authors.forename: Michael
authors.initials: M
authors.lastname: Bullard
authors.forename: Benjamin
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Maria
authors.initials: M
authors.lastname: Ospina
authors.forename: Grant
authors.initials: G
authors.lastname: Innes
mesh_terms: D003441:Crowding; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D015201:Meta-Analysis as Topic; D010820:Physicians; D016032:Randomized Controlled Trials as Topic; D014218:Triage / Q000379:methods*