title: Physician in Triage Versus Rotational Patient Assignment.
abstract: BACKGROUND
  Physician in triage and rotational patient assignment are different front-end processes that are designed to improve patient flow, but there are little or no data comparing them.
  
  
  OBJECTIVE
  To compare physician in triage with rotational patient assignment with respect to multiple emergency department (ED) operational metrics.
  
  
  METHODS
  Design-Retrospective cohort review. Patients-Patients seen on 23 days on which we utilized a physician in triage with those patients seen on 23 matched days when we utilized rotational patient assignment.
  
  
  RESULTS
  There were 1,869 visits during physician in triage and 1,906 visits during rotational patient assignment. In a simple comparison, rotational patient assignment was associated with a lower median length of stay (LOS) than physician in triage (219 min vs. 233 min; difference of 14 min; 95% confidence interval [CI] 5-27 min). In a multivariate linear regression incorporating multiple confounders, there was a nonsignificant reduction in the geometric mean LOS in rotational patient assignment vs. physician in triage (204 min vs. 217 min; reduction of 6.25%; 95% CI -3.6% to 15.2%). There were no significant differences between groups for left before being seen, left subsequent to being seen, early (within 72 h) returns, early returns with admission, or complaint ratio.
  
  
  CONCLUSIONS
  In a single-site study, there were no statistically significant differences in important ED operational metrics between a physician in triage model and a rotational patient assignment model after adjusting for confounders.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, Arizona; College of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Traub
authors.affiliation: Department of Health Science Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Bartley
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, Arizona; College of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Vernon D
authors.initials: VD
authors.lastname: Smith
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, Arizona; College of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Roshanak
authors.initials: R
authors.lastname: Didehban
authors.affiliation: Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, Arizona; College of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Lipinski
authors.affiliation: Harvard Kennedy School, Cambridge, Massachusetts.
authors.forename: Soroush
authors.initials: S
authors.lastname: Saghafian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D017064:Process Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D014218:Triage / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data
keywords: ED front-end; physician in triage; rotational patient assignment