title: Resident-initiated advanced triage effect on emergency department patient flow.
abstract: BACKGROUND
  Emergency Department (ED) overcrowding is a national problem. Initiating orders in triage has been shown to decrease length of stay (LOS), however, nurse, physician assistant, and attending physician advanced triage have all been criticized.
  
  
  OBJECTIVE
  Our primary objective was to show that Emergency Medicine resident-initiated advanced triage shortens patient LOS. Our secondary objective was to evaluate whether or not resident triage decreases the number of patients who left prior to medical screening (LPTMS).
  
  
  METHODS
  This prospective interventional study was performed in a 42-bed, Level III trauma center, academic ED in the United States, with an annual census of approximately 41,000 patients. A junior or senior Emergency Medicine resident initiated orders on 16 weekdays for 6 h daily on patients presenting to triage. Patients evaluated during the 6-h period on other weekdays served as the control. The study was powered to detect a reduction in LOS of 45 min. Multivariable median regression was used to compare length of stay and Fisher's exact test to compare proportions.
  
  
  RESULTS
  There were 1346 patients evaluated in the ED during the intervention time. Regression analysis showed a 37-min decrease in median LOS for patients on intervention days as compared to control days (p = 0.02). The proportion of patients who LPTMS was not statistically different (p = 0.7) for intervention days (96/1346, 7.13%) compared to control days (136/1810, 7.51%).
  
  
  CONCLUSIONS
  Resident-initiated advanced triage is an effective method to decrease patient LOS, however, our effect size is smaller than predicted and did not significantly affect the percent of patients leaving before medical screening.
authors.affiliation: EM Residency, PGY II.
authors.forename: Irina
authors.initials: I
authors.lastname: Svirsky
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Stoneking
authors.forename: Kristi
authors.initials: K
authors.lastname: Grall
authors.forename: Matthew
authors.initials: M
authors.lastname: Berkman
authors.forename: Uwe
authors.initials: U
authors.lastname: Stolz
authors.forename: Farshad
authors.initials: F
authors.lastname: Shirazi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D016037:Single-Blind Method; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration*; D055815:Young Adult
keywords: advanced triage; length of stay; patient flow; physician triage