Emergency department provider in triage: assessing site-specific rationale, operational feasibility, and financial impact.

Autor: Franklin BJ; University of Michigan Medical School Ann Arbor Michigan USA., Li KY; Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USA.; Department of Emergency Medicine Michigan Medicine Ann Arbor Michigan USA.; Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA., Somand DM; Department of Emergency Medicine Michigan Medicine Ann Arbor Michigan USA.; Division of Emergency Critical Care Michigan Medicine Ann Arbor Michigan USA., Kocher KE; Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USA.; Department of Emergency Medicine Michigan Medicine Ann Arbor Michigan USA., Kronick SL; Department of Emergency Medicine Michigan Medicine Ann Arbor Michigan USA., Parekh VI; Department of Internal Medicine Michigan Medicine Ann Arbor Michigan USA., Goralnick E; Department of Emergency Medicine Brigham and Women's Hospital Boston Massachusetts USA.; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts USA., Nix AT; Taubman Health Sciences Library University of Michigan Ann Arbor Michigan USA., Haas NL; Department of Emergency Medicine Michigan Medicine Ann Arbor Michigan USA.; Division of Emergency Critical Care Michigan Medicine Ann Arbor Michigan USA.
Jazyk: angličtina
Zdroj: Journal of the American College of Emergency Physicians open [J Am Coll Emerg Physicians Open] 2021 May 24; Vol. 2 (3), pp. e12450. Date of Electronic Publication: 2021 May 24 (Print Publication: 2021).
DOI: 10.1002/emp2.12450
Abstrakt: Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub-optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs-which typically involve, at a minimum, a physician or advanced practice provider conducting an initial screening exam and potentially initiating treatment and diagnostic testing at the time of triage-are frequently endorsed as a mechanism to reduce ED length of stay (LOS) and therefore mitigate crowding, improve patient satisfaction, and improve ED operational and financial performance. However, the peer-reviewed evidence regarding the impact of PIT programs on measures including ED LOS, wait times, and costs (as variously defined) is mixed. Mechanistically, PIT programs exert their effects by initiating diagnostic work-ups earlier and, sometimes, by equipping triage providers to directly disposition patients. However, depending on local contextual factors-including the co-existence of other front-end interventions and delays in ED throughput not addressed by PIT-we demonstrate how these features may or may not ultimately translate into reduced ED LOS in different settings. Consequently, site-specific analysis of the root causes of excessive ED LOS, along with mechanistic assessment of potential countermeasures, is essential for appropriate deployment and successful design of PIT programs at individual EDs. Additional motivations for implementing PIT programs may include their potential to enhance patient safety, patient satisfaction, and team dynamics. In this conceptual article, we address a gap in the literature by demonstrating the mechanisms underlying PIT program results and providing a framework for ED decision-makers to assess the local rationale for, operational feasibility of, and financial impact of PIT programs.
Competing Interests: The authors declare no conflicts of interest.
(© 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)
Databáze: MEDLINE