Traditional nurse triage vs physician telepresence in a pediatric ED.
OBJECTIVE
The objective of the study is to compare traditional nurse triage (TNT) in a pediatric emergency department (PED) with physician telepresence (PTP).


METHODS
This is a prospective 2 × 2 crossover study with random assignment using a sample of walk-in patients seeking care in a PED at a large, tertiary care children's hospital, from May 2012 to January 2013. Outcomes of triage times, documentation errors, triage scores, and survey responses were compared between TNT and PTP. Comparison between PTP to actual treating PED physicians regarding the accuracy of ordering blood and urine tests, throat cultures, and radiologic imaging was also studied.


RESULTS
Paired samples t tests showed a statistically significant difference in triage time between TNT and PTP (P = .03) but no significant difference in documentation errors (P = .10). Triage scores of TNT were 71% accurate, compared with PTP, which were 95% accurate. Both parents and children had favorable scores regarding PTP, and most indicated that they would prefer PTP again at their next PED visit. Physician telepresence diagnostic ordering was comparable with the actual PED physician ordering, showing no statistical differences.


CONCLUSIONS
Using PTP technology to remotely perform triage is a feasible alternative to traditional nurse triage, with no clinically significant differences in time, triage scores, errors, and patient and parent satisfaction.
Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90027, USA. Electronic address: gmarconi@chla.usc.edu.
Greg P
GP
Marconi
Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90027, USA.
Todd
T
Chang
Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90027, USA.
Phung K
PK
Pham
Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90027, USA.
Daniel N
DN
Grajower
Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90027, USA.
Alan L
AL
Nager
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004282:Documentation / Q000592:standards; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009730:Nursing Assessment; D010372:Pediatrics / Q000379:methods*; D010819:Physician's Role; D011446:Prospective Studies; D011897:Random Allocation; D019114:Remote Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors; D014218:Triage / Q000379:methods*; D000078329:Workforce