title: Use of Physician-in-Triage Model in the Management of Abdominal Pain in an Emergency Department Observation Unit.
abstract: BACKGROUND
  Given the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission).
  
  
  METHODS
  This was a retrospective cohort study of patients admitted to a protocol-driven EDOU with a diagnosis of abdominal pain in a single university hospital center ED. We obtained compiled data for all patients admitted to the EDOU with a diagnosis of abdominal pain that met EDOU protocol admission criteria. We divided data for each cohort into age, gender, payer status, and LOS. The data were then analyzed to assess any significant differences between the cohorts.
  
  
  RESULTS
  A total of 327 patients were eligible for this study (85 triage group, 242 main ED group). The total success rate was 90.8% (n=297) and failure rate was 9.2% (n=30). We observed no significant differences in success rates between those dispositioned to the EDOU by triage physicians (90.6%) and those via the traditional route (90.5 % p) = 0.98. However, we found a significant difference between the two groups regarding total LOS with significantly shorter main ED times and EDOU times among patients sent to the EDOU by the physician-in-triage group (p< .001).
  
  
  CONCLUSIONS
  There were no significant differences in EDOU disposition outcomes in patients admitted to an EDOU by a physician-in-triage or via the traditional route. However, there were statistically significant shorter LOSs in patients admitted to the EDOU by triage physicians. The data from this study support the implementation of a physician-in-triage model in combination with the EDOU in improving efficiency in the treatment of abdominal pain. This knowledge may spur action to cut healthcare costs and improve patient flow and timely decision-making in hospitals with EDOUs.
authors.affiliation: University of California, Department of Emergency Medicine, Irvine, California.
authors.forename: John R
authors.initials: JR
authors.lastname: Marshall
authors.affiliation: University of California, Department of Emergency Medicine, Irvine, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Katzer
authors.affiliation: University of California, Department of Emergency Medicine, Irvine, California.
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfipour
authors.affiliation: University of California, Department of Emergency Medicine, Irvine, California.
authors.forename: Bharath
authors.initials: B
authors.lastname: Chakravarthy
authors.affiliation: University of California, Department of Emergency Medicine, Irvine, California.
authors.forename: Siri
authors.initials: S
authors.lastname: Shastry
authors.affiliation: University of California, Department of Emergency Medicine, Irvine, California.
authors.forename: Jessica
authors.initials: J
authors.lastname: Andrusaitis
authors.affiliation: University of California, Department of Emergency Medicine, Irvine, California.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Anderson
authors.affiliation: University of California, Department of Emergency Medicine, Irvine, California.
authors.forename: Erik D
authors.initials: ED
authors.lastname: Barton
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014218:Triage / Q000191:economics / Q000592:standards; D055815:Young Adult