title: Improving emergency department throughput: An outcomes evaluation of two additional models of care.
abstract: OBJECTIVE
  The aim of this study was to explore the impact of incorporating a physician at triage (PAT) and the implementation of a medical assessment unit (MAU) on emergency department (ED) patient throughput.
  
  
  METHODS
  A retrospective comparative analysis of two additional models of care (standard care, T1; PAT, T2 and PATplusMAU, T3) was undertaken. Patient presentations to a large public teaching hospital in South-East Queensland between 10th January 2013 and 25th February 2013, and the same time period in 2012, were included. The impact of these care models on ED length of stay and other outcomes (time to be seen by a clinician, time from bed request to ward transfer, meeting 4 hour transit targets, admission rates and the proportion of patients who did not wait) were compared.
  
  
  RESULTS
  Compared to standard care, ED length of stay appeared to decrease with the introduction of both models, but was only significantly decreased after PATplusMAU was implemented (2013; T1, 186 min; T2, 181 min; T3, 175 min: T1 vs T3, P < 0.001). Outcomes that improved included: time to be seen by a clinician, proportion of patients who did not wait; increase in meeting 4-hour length of stay target for both admitted and not-admitted patients.
  
  
  CONCLUSIONS
  Placing a physician at triage and implementing a medical assessment unit were viable models of care that promoted patient flow and helped meet several time-sensitive health service targets.
authors.affiliation: School of Nursing & Midwifery, Griffith Health, Gold Coast Campus, Griffith University, QLD 4222, Australia. Electronic address: e.elder@griffith.edu.au.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Elder
authors.affiliation: Department of Emergency Medicine & Griffith Health Institute, Gold Coast Hospital and Health Service & Griffith University, Southport, QLD 4215, Australia.
authors.forename: Amy N B
authors.initials: AN
authors.lastname: Johnston
authors.affiliation: Department of Emergency Medicine & Griffith Health Institute, Gold Coast Hospital and Health Service & Griffith University, Southport, QLD 4215, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Crilly
mesh_terms: D000293:Adolescent; D000328:Adult; D001509:Bed Occupancy / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010820:Physicians / Q000706:statistics & numerical data / Q000600:supply & distribution / Q000639:trends; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage / Q000379:methods / Q000706:statistics & numerical data; D000078329:Workforce
keywords: Emergency department; Length of stay; Medical assessment units; National Emergency Access Targets (NEAT); Outcomes; Physician at triage