Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

Cheng, Ivy; Castrèn, Maaret; Kiss, Alex; Zwarenstein, Merrick; Brommels, Mats; Mittmann, Nicole

doi:10.1017/cem.2015.88

Cited by 17 publications

(13 citation statements)

References 50 publications

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“…[35] On the other hand, triage liaison physicians’ (TLPs) role also proposes throughput factors contributed to ED overcrowding. The TLP's role is to work with triage staff to expedite the care of patients based on their medical needs, especially for those with unpredictable waiting times.…”

Section: Resultsmentioning

confidence: 99%

Overcrowding in emergency departments: A review of strategies to decrease future challenges

et al. 2017

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Emergency departments (EDs) are the most challenging ward with respect to patient delay. The goal of this study is to present strategies that have proven to reduce delay and overcrowding in EDs. In this review article, initial electronic database search resulted in a total of 1006 articles. Thirty articles were included after reviewing full texts. Inclusion criteria were assessments of real patient flows and implementing strategies inside the hospitals. In this study, we discussed strategies of team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track. Patients might be directed to different streaming channels depending on clinical status and required practitioners. The most comprehensive strategy is ideal ED patient journey models, in which ten interrelated substrategies are provided. ED leaders should apply strategies that provide a continuous care process without deeply depending on external services.

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Section: Resultsmentioning

confidence: 99%

Overcrowding in emergency departments: A review of strategies to decrease future challenges

et al. 2017

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“…We found an ICER of €31 per ED LOS hour saved, which is probably acceptable for large tertiary care centers with high patient volume. Other authors using the same effectiveness metric for a study of triage in the ED reported ICERs of $3,597.27 ($1,729.47 to infinity) per additional patient seen, $75.37 ($67.99 to $105.30) per physician hour saved, and $112.99 ($74.68 to $251.43) per ED length of stay hour saved 21 . Earlier availability of test results may translate into an unnecessary increase in volume of laboratory testing ordered by emergency physicians during POCT periods and may have contributed to additional costs.…”

Section: Discussionmentioning

confidence: 99%

Impact of Point‐of‐care Testing on Length of Stay of Patients in the Emergency Department: A Cluster‐randomized Controlled Study

Hausfater

Hajage

Bulsei

et al. 2020

Academic Emergency Medicine

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Objectives: Crowding is a frequent concern in the emergency department (ED). Laboratory point-of-care testing (POCT) has been proposed to decrease patients' length of stay (LOS). Our objective was to determine whether an extended panel of POCT solutions could reduce LOS. Methods: This was a single-center, prospective, open-label, controlled cluster-randomized study. Blood test processing was randomized into 1-week inclusion periods: interventional arm (laboratory analyses performed on POCT analyzers implemented in the ED) or control arm (central laboratory). The primary endpoint was LOS of patients in the ED. Secondary endpoints were time to result (TTR), ED crowding surrogates, and average total cost of an ED visit in each arm. Results: A total of 23,231 patients were included and 20,923 were analyzed for the main outcome measure. Mean AE SD age was 46 AE 20 years, and 7,905 (36%) underwent blood sampling. Mean AE SD LOSs were 203 AE 161 and 210 AE 168 minutes in the POCT and control arms, respectively. LOS reduction for the entire ED population was À9 minutes (95% confidence interval [CI] = À22 to 5, p = 0.22) compared to the control arm and À17 minutes (95% CI = À34.0 to 0.6, p = 0.06) for patients undergoing blood sampling. The mean AE SD TTRs were 28 AE 31 and 79 AE 34 minutes in the POCT and control arms, respectively (TTR reduction = À51 minutes, 95% CI = À54 to À48 minutes, p < 0.001).

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“…Cost of health interventions includes health services delivery costs such as cost health personnel, investigations, medicines, other health supplies etc. [11][12][13][14][15][16][17][18][19][20] It can also include costs which are not directly related to service delivery, such as the costs of the building and equipment, costs of health facility administration. [11][12][13][14][15][16][17][18][19][20] Next step is to estimate the amount of the resources used in the interventions and value each resource used in monitory terms.…”

Section: Identifying and Valuing Costsmentioning

confidence: 99%

Cost-effectiveness analysis for decision making in health care-concept, relevance and methodological challenges

Mughal

Jehan

Albejaidi

et al. 2017

Int J Community Med Public Health

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With continuous rise in health spending among countries, the need to make use of limited resources in health systems has become crucial. Health policy makers in countries strive to identify the interventions which can contribute to improving health outcomes. Techniques of economic evaluation, especially cost effectiveness analysis (CEA) have been widely applied in health sector to identify interventions that are more effective in terms of resources utilization. An understanding of CEA will not only help policy makers to take appropriate decisions in health sector but also in judicious spending of scarce resources. However, CEA studies have been flaunted with series of methodological challenges and practicability issues. This paper provides an introduction to CEA as one of the techniques of economic evaluation of health interventions and its relevance in making decisions in health sector. The paper also discusses some of the practical issues that arise while doing a CEA study in the health sector.

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Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

Cited by 17 publications

References 50 publications

Overcrowding in emergency departments: A review of strategies to decrease future challenges

Overcrowding in emergency departments: A review of strategies to decrease future challenges

Impact of Point‐of‐care Testing on Length of Stay of Patients in the Emergency Department: A Cluster‐randomized Controlled Study

Cost-effectiveness analysis for decision making in health care-concept, relevance and methodological challenges

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