Impact of Provider-In-Triage in a Safety-Net Hospital.

Emergency Service, Hospital Hospitals, Urban Humans Length of Stay Retrospective Studies Safety-net Providers Triage
left without being seen operations overcrowding provider-in-triage throughput

Journal

The Journal of emergency medicine
ISSN: 0736-4679
Titre abrégé: J Emerg Med
Pays: United States
ID NLM: 8412174

Informations de publication

Date de publication:
Sep 2020
Historique:
received: 02 03 2020
revised: 17 04 2020
accepted: 28 04 2020
pubmed: 1 7 2020
medline: 24 6 2021
entrez: 30 6 2020
Statut: ppublish

Résumé

Increasing emergency department (ED) utilization has contributed to ED overcrowding, with longer ED length of stay (EDLOS) and more patients leaving without being seen (LWBS), and is associated with higher morbidity and mortality rates. Previous studies of provider in triage (PIT) have shown decreased LWBS, but variable improvements in EDLOS. We evaluated the impact of PIT implementation in an urban safety-net hospital on commonly reported ED throughput metrics. This before-and-after study was performed at an academic urban safety hospital. We implemented a PIT team that screened ambulatory ED patients for early discharge or expedited workup. The PIT intervention was implemented 3 days a week from January through April 2019. As controls, we compared throughput metrics from when PIT was unavailable (Group 2) and from 1 year prior (Group 3). There were significantly (p < 0.001) lower rates of LWBS in Group 1 (4.8%, 95% confidence interval [CI] 4.1-5.8%) compared with 2 (7.3%, 95% CI 5.5-9.7%) and 3 (7.8%, 95% CI 6.9-9.0%). Door-to-doctor times were significantly (p < 0.001) lower for Group 1 (148 min, interquartile range [IQR] 88, 226 min) compared with 2 (187 min, IQR 95.5, 266 min) and 3 (215 min, IQR 131, 290 min). EDLOS was significantly (p < 0.001) shorter for Group 1 (337 min, IQR 215, 468 min) compared with 2 (385 min, IQR 271, 516 min) and 3 (413 min, IQR 299, 538 min). We found significantly lower LWBS rates, shorter EDLOS, and shorter door-to-doctor times after PIT implementation. Compared with previous studies in a variety of settings, we found that PIT significantly improved LWBS and all throughput metrics in a safety net setting.

Sections du résumé

BACKGROUND BACKGROUND
Increasing emergency department (ED) utilization has contributed to ED overcrowding, with longer ED length of stay (EDLOS) and more patients leaving without being seen (LWBS), and is associated with higher morbidity and mortality rates. Previous studies of provider in triage (PIT) have shown decreased LWBS, but variable improvements in EDLOS.
OBJECTIVES OBJECTIVE
We evaluated the impact of PIT implementation in an urban safety-net hospital on commonly reported ED throughput metrics.
METHODS METHODS
This before-and-after study was performed at an academic urban safety hospital. We implemented a PIT team that screened ambulatory ED patients for early discharge or expedited workup. The PIT intervention was implemented 3 days a week from January through April 2019. As controls, we compared throughput metrics from when PIT was unavailable (Group 2) and from 1 year prior (Group 3).
RESULTS RESULTS
There were significantly (p < 0.001) lower rates of LWBS in Group 1 (4.8%, 95% confidence interval [CI] 4.1-5.8%) compared with 2 (7.3%, 95% CI 5.5-9.7%) and 3 (7.8%, 95% CI 6.9-9.0%). Door-to-doctor times were significantly (p < 0.001) lower for Group 1 (148 min, interquartile range [IQR] 88, 226 min) compared with 2 (187 min, IQR 95.5, 266 min) and 3 (215 min, IQR 131, 290 min). EDLOS was significantly (p < 0.001) shorter for Group 1 (337 min, IQR 215, 468 min) compared with 2 (385 min, IQR 271, 516 min) and 3 (413 min, IQR 299, 538 min).
CONCLUSIONS CONCLUSIONS
We found significantly lower LWBS rates, shorter EDLOS, and shorter door-to-doctor times after PIT implementation. Compared with previous studies in a variety of settings, we found that PIT significantly improved LWBS and all throughput metrics in a safety net setting.

Identifiants

DOI: 10.1016/j.jemermed.2020.04.059 PMID: 32595053
pubmed: 32595053
pii: S0736-4679(20)30391-7
doi: 10.1016/j.jemermed.2020.04.059
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

459-465

Informations de copyright

Copyright © 2020 Elsevier Inc. All rights reserved.

Auteurs

Rushabh Shah (R)

Department of Emergency Medicine, Kings County Hospital, Brooklyn, New York; Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York.

Richard Leno (R)

Department of Emergency Medicine, Kings County Hospital, Brooklyn, New York; Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York.

Richard Sinert (R)

Department of Emergency Medicine, Kings County Hospital, Brooklyn, New York; Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York.

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Classifications MeSH

questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Impact of Provider-In-Triage in a Safety-Net Hospital.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Hôpitaux urbains › Impact of Provider-In-Triage in a Safety-Net Hospital.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Impact of Provider-In-Triage in a Safety-Net Hospital.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Impact of Provider-In-Triage in a Safety-Net Hospital.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Impact of Provider-In-Triage in a Safety-Net Hospital.
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Professionnels du filet de sécurité sanitaire › Impact of Provider-In-Triage in a Safety-Net Hospital.
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Triage › Impact of Provider-In-Triage in a Safety-Net Hospital.