title: Managing patient flow with triage streaming to identify patients for Dutch emergency nurse practitioners.
abstract: BACKGROUND
  We developed a stream system to the current triangle system in order to manage patient flow at the emergency department and to clarify ENP role boundaries.
  
  
  METHODS
  Data on admission and death rates--indicating injury severity--and data on length of stay--indicating resource utilisation--were collected from 48,397 patients triaged in the Netherlands in 2009.
  
  
  RESULTS
  A total of 24,294 (50.2%) patients were triaged as 'suitable for treatment by an ENP' (ENP-stream). Remaining patients were triaged 'medium care' or 'high care'. In the medium and high care groups, significantly more admissions took place (6100, 25.3%) and significantly more patients died (31, 0.1%) compared to the patient group in the ENP-stream (admissions: 840, 3.5%, p<0.001 and deaths 0, 0.0%, p<0.001). The ENP-streaming is an accurate predictor of not needing to be admitted (PPV=97%) and of ED survival (PPV=100%). Mean length of stay was significantly shorter for patients in the ENP-stream compared to the other patients (back transformed values: 74 vs. 147 min, p<0.001).
  
  
  CONCLUSIONS
  This study showed excellent correlation between the ENP-streaming and patients' injury severity and resource utilisation, suggesting high internal validity of our triage streaming system. It clarifies the ENP role, minimising the subjectivity of patient allocation.
authors.affiliation: Emergency Department, Medical Centre Haaglanden Location Westeinde, The Hague, The Netherlands. c.van.der.linden@mchaaglanden.nl
authors.forename: Christien
authors.initials: C
authors.lastname: van der Linden
authors.forename: Robert
authors.initials: R
authors.lastname: Lindeboom
authors.forename: Naomi
authors.initials: N
authors.lastname: van der Linden
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
mesh_terms: D016009:Chi-Square Distribution; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D009426:Netherlands; D009722:Nurse Practitioners; D024802:Nurse's Role; D010343:Patient Admission / Q000706:statistics & numerical data; D014218:Triage