title: Initiating Diagnostic Studies on Patients With Abdominal Pain in the Waiting Room Decreases Time Spent in an Emergency Department Bed: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The effect of clinician screening of patients in the emergency department (ED) waiting room is unclear. This study aims to determine the effect of initiating laboratory and imaging studies from the ED waiting room on time in a bed, total ED time, and likelihood of patients leaving before completion of service.
  
  
  METHODS
  This was a prospective, randomized, controlled trial evaluating 1,659 nonpregnant adults with a chief complaint of abdominal pain, conducted in a public hospital ED when all ED beds were occupied and patients were in the waiting room awaiting definitive evaluation. After a brief screening examination, stable patients were randomized to either rapid medical evaluation (RME)+waiting room diagnostic testing (WRDT) or RME-only groups. Patients randomized to the RME+WRDT group had laboratory and imaging studies ordered at the discretion of the screening provider while in the waiting room. The primary outcome was time in an ED bed. Secondary outcomes were total ED time and rate of leaving before completion of service. Linear and logistic regression models were used to compare outcomes between groups.
  
  
  RESULTS
  Between July 2014 and May 2015, 1,659 patients completed the study, 848 patients in the RME+WRDT group and 811 in the RME-only group. Baseline demographic characteristics were similar between groups. Patients in the RME+WRDT group had a significantly shorter mean time in an ED bed than the RME-only group, 245 minutes compared with 277 minutes (adjusted difference of 31 minutes; 95% confidence interval [CI] 16 to 46 minutes). The RME+WRDT group also had significantly shorter mean total ED time from arrival to disposition than the RME-only group, 460 minutes compared with 504 minutes (adjusted difference 42 minutes; 95% CI 22 to 63 minutes). Of the 1,659 patients enrolled, 181 left before completion of service: 78 of 848 patients (9%) in the RME+WRDT group compared with 103 of 811 (13%) in the RME-only group (difference 3.5%; 95% CI 0.5% to 6.5%). By the end of their ED visit, patients in the RME+WRDT group had significantly more types of diagnostic studies ordered than those in the RME-only group, 2.59 versus 2.03 total unique test categories by location ordered (difference 0.56; 95% CI 0.44 to 0.68).
  
  
  CONCLUSIONS
  Initiating diagnostic testing in the waiting room reduced time spent in an ED bed, total ED time, and rates of leaving before completion of service. For clinicians screening patients in the waiting room, initiating diagnostic evaluations may improve throughput in crowded EDs.
authors.affiliation: Department of Emergency Medicine, David Geffen School of Medicine, Olive View-UCLA Emergency Medicine, Sylmar, CA. Electronic address: tomerbegaz@gmail.com.
authors.forename: Tomer
authors.initials: T
authors.lastname: Begaz
authors.affiliation: Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.affiliation: Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Tristan R
authors.initials: TR
authors.lastname: Grogan
authors.affiliation: Department of Emergency Medicine, David Geffen School of Medicine, Olive View-UCLA Emergency Medicine, Sylmar, CA.
authors.forename: David
authors.initials: D
authors.lastname: Talan
authors.affiliation: Department of Emergency Medicine, David Geffen School of Medicine, Olive View-UCLA Emergency Medicine, Sylmar, CA.
authors.forename: Breena R
authors.initials: BR
authors.lastname: Taira
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D000328:Adult; D019411:Clinical Laboratory Techniques / Q000379:methods / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D014850:Waiting Lists