title: Physician in triage improves emergency department patient throughput.
abstract: To determine if a physician in triage (PIT) improves Emergency Department (ED) patient flow in a community teaching hospital. This is an interventional study comparing patient flow parameters for the 3-month periods before and after implementation of a PIT model. During the interventional time an additional attending physician was assigned to triage from 1 p.m. to 9 p.m. daily. Outcome measures were median time to attending physician evaluation, median length of stay (LOS), number of patients who left without being seen (LWBS), and total time and number of days on ambulance diversion. Non-normally distributed values were compared with the Wilcoxon rank sum test. Proportions were compared with Chi-square test. Outcome measures were available for 17,631 patients, of whom 8,620 were seen before the initiation of PIT, and 9,011 were seen after PIT was implemented. For all patients, the median time from registration to attending physician evaluation was reduced by 36 min (1:41 to 1:05, p < 0.01) while the median LOS for all patients was reduced by 12 min (3:51 to 3:39, p < 0.01) after the intervention. Both the number of days on diversion (24 vs. 9 days) and total time on diversion (68 h 25 min vs. 26 h 7 min) were decreased, p < 0.01. Finally, there was a slight reduction in the number of patients who LWBS from 1.5 to 1.3 %, but this was not statistically significant (p = 0.36). Patient flow parameters in a community teaching hospital were modestly improved as a result of PIT implementation.
authors.affiliation: Department of Emergency Medicine, Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02138, USA. jimperat@mah.harvard.edu
authors.forename: Jason
authors.initials: J
authors.lastname: Imperato
authors.forename: Darren Scott
authors.initials: DS
authors.lastname: Morris
authors.forename: David
authors.initials: D
authors.lastname: Binder
authors.forename: Christopher
authors.initials: C
authors.lastname: Fischer
authors.forename: John
authors.initials: J
authors.lastname: Patrick
authors.forename: Leon Dahomey
authors.initials: LD
authors.lastname: Sanchez
authors.forename: Gary
authors.initials: G
authors.lastname: Setnik
mesh_terms: D003441:Crowding; D017598:Efficiency, Organizational; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D006801:Humans; D007902:Length of Stay; D008404:Massachusetts; D010360:Patient Transfer; D010819:Physician's Role; D012189:Retrospective Studies; D014218:Triage