Can interprofessional teamwork reduce patient throughput times? A longitudinal single-centre study of three different triage processes at a Swedish emergency department

Abstract

ObjectiveTo determine the impact on emergency department (ED) throughput times and proportion of patients who leave without being seen by a physician (LWBS) of two triage interventions, where comprehensive nurse-led triage was first replaced by senior physician-led triage and then by interprofessional teamwork.DesignSingle-centre before-and-after study.SettingAdult ED of a Swedish urban hospital.ParticipantsPatients arriving on weekdays 08:00 to 21:00 during three 1-year periods in the interval May 2012 to November 2015. A total of 185 806 arrivals were included.InterventionsSenior physicians replaced triage nurses May 2013 to May 2014. Interprofessional teamwork replaced the triage process on weekdays 08:00 to 21:00 November 2014 to November 2015.Main outcome measuresPrimary outcomes were the median time to physician (TTP) and the median length of stay (LOS). Secondary outcome was the LWBS rate.ResultsThe crude median LOS was shortest for teamwork, 228 min (95% CI 226.4 to 230.5) compared with 232 min (95% CI 230.8 to 233.9) for nurse-led and 250 min (95% CI 248.5 to 252.6) for physician-led triage. The adjusted LOS for the teamwork period was 16 min shorter than for nurse-led triage and 23 min shorter than for physician-led triage. The median TTP was shortest for physician-led triage, 56 min (95% CI 54.5 to 56.6) compared with 116 min (95% CI 114.4 to 117.5) for nurse-led triage and 74 min (95% CI 72.7 to 74.8) for teamwork. The LWBS rate was 1.9% for nurse-led triage, 1.2% for physician-led triage and 3.2% for teamwork. All outcome measure differences had two-tailed p values<0.01.ConclusionsInterprofessional teamwork had the shortest length of stay, a shorter time to physician than nurse-led triage, but a higher LWBS rate. Interprofessional teamwork may be a useful approach to reducing ED throughput times.

A perception survey on the roles of nurses during triage in a selected public hospital in Kwazulu-Natal Province, South Africa

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Emergency Medicine Service Can Interpret Abdomino-Pelvic Ct Scans With Close to the Same Accuracy as Radiology Service

“…Emergency Medicine (EM) specialists are frontline of managing the trauma patients whom prompt and accurate diagnosis of possible injuries is crucial. They play a vital role in surviving these patients, and improving their capabilities in the field of trauma management, can play a significant role in reducing trauma mortality and health care system cost (10)(11)(12). Initial management of the trauma patient is directed at identification of life-threatening injuries.…”

A Review of Assessment and Treatment of Trauma in Emergency Department

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