title: Improved quality and efficiency after the introduction of physician-led team triage in an emergency department.
abstract: BACKGROUND
  Overcrowding in the emergency department (ED) may negatively affect patient outcomes, so different triage models have been introduced to improve performance. Physician-led team triage obtains better results than other triage models. We compared efficiency and quality measures before and after reorganization of the triage model in the ED at our county hospital.
  
  
  METHODS
  We retrospectively compared two study periods with different triage models: nurse triage in 2008 (baseline) and physician-led team triage in 2012 (follow-up). Physician-led team triage was in use during day-time and early evenings on weekdays. Data were collected from electronic medical charts and the National Mortality Register.
  
  
  RESULTS
  We included 20,073 attendances in 2008 and 23,765 in 2012. The time from registration to physician presentation decreased from 80 to 33 min (P < 0.001), and the length of stay decreased from 219 to 185 min (P < 0.001) from 2008 to 2012, respectively. All of the quality variables differed significantly between the two periods, with better results in 2012. The odds ratio for patients who left before being seen or before treatment was completed was 0.62 (95% confidence interval 0.54-0.72). The corresponding result for unscheduled returns was 0.36 (0.32-0.40), and for the mortality rates within 7 and 30 days 0.72 (0.59-0.88) and 0.84 (0.73-0.97), respectively. The admission rate was 37% at baseline and 32% at follow-up (P < 0.001).
  
  
  CONCLUSIONS
  Physician-led team triage improved the efficiency and quality in EDs.
authors.affiliation: a Centre for Clinical Research , Uppsala University, Västmanlands County Hospital , Västerås , Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Burström
authors.affiliation: a Centre for Clinical Research , Uppsala University, Västmanlands County Hospital , Västerås , Sweden.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Engström
authors.affiliation: b Department of Clinical Science and Education , Karolinska Institutet , Stockholm , Sweden.|c Department of Emergency Medicine , Helsinki University Hospital and Helsinki University , Finland.
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.affiliation: a Centre for Clinical Research , Uppsala University, Västmanlands County Hospital , Västerås , Sweden.
authors.forename: Tony
authors.initials: T
authors.lastname: Wiklund
authors.affiliation: a Centre for Clinical Research , Uppsala University, Västmanlands County Hospital , Västerås , Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Enlund
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010819:Physician's Role; D011787:Quality of Health Care; D012189:Retrospective Studies; D014218:Triage
keywords: Emergency physician; LOS; left before treatment completed; mortality; physician team triage; quality measures; unscheduled return