title: Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department.
abstract: OBJECTIVE
  Overcapacity issues plague emergency departments (EDs). Studies suggest that triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs. We evaluated whether a physician assistant (PA), acting as a TLP, would shorten LOS and decrease LWBS rates.
  
  
  METHODS
  The authors used an observational cohort controlled before-and-after study design with predefined outcome measures, comparing 8 pilot days to 8 control days. The TLP evaluated all Emergency Severity Index (ESI) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients.
  
  
  RESULTS
  A total of 353 patients were included on pilot days and 371 on control days. LOS was shorter on pilot days than control days (median [interquartile range {IQR}] = 229 [168 to 303] minutes vs. 270 [187 to 372] minutes, p < 0.001). Waiting room times were similar between pilot and control days (median [IQR] = 69 [20 to 119] minutes vs. 70 [19 to 137] minutes, p = 0.408), but treatment room times were shorter (median [IQR] = 151 [92 to 223] minutes vs. 187 [110 to 254] minutes, p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4% vs. 9.7%, p < 0.001).
  
  
  CONCLUSIONS
  The addition of a PA as a TLP was associated with a 41-minute decrease in median total LOS and a lower proportion of patients who LWBS. The decrease in total LOS is likely attributable to the addition of the TLP, with patients having shorter duration in treatment rooms on pilot days compared to control days.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA. nestler.david@mayo.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Nestler
authors.forename: Alesia R
authors.initials: AR
authors.lastname: Fratzke
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Church
authors.forename: Lori
authors.initials: L
authors.lastname: Scanlan-Hanson
authors.forename: Annie T
authors.initials: AT
authors.lastname: Sadosty
authors.forename: Michael P
authors.initials: MP
authors.lastname: Halasy
authors.forename: Janet L
authors.initials: JL
authors.lastname: Finley
authors.forename: Andy
authors.initials: A
authors.lastname: Boggust
authors.forename: Erik P
authors.initials: EP
authors.lastname: Hess
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D017598:Efficiency, Organizational; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D020380:Needs Assessment; D010348:Patient Care Team / Q000458:organization & administration*; D010823:Physician Assistants; D010865:Pilot Projects; D058996:Quality Improvement; D014218:Triage / Q000458:organization & administration*; D014850:Waiting Lists; D057188:Workflow