Emergency Department Rapid Medical Assessment: Overall Effect and Mechanistic Considerations

Traub, Stephen J.; Wood, Joseph P.; Kelley, James R.; Nestler, David M.; Chang, Yu Hui; Saghafian, Soroush; Lipinski, Christopher A.

doi:10.1016/j.jemermed.2014.12.025

Cited by 36 publications

(19 citation statements)

References 29 publications

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“…To our knowledge, so far Traub [ 35 ] was the only one to report a statistically significant increase in ED LOS upon the introduction of team triage (rapid medical assessment team (RMA)). When stratifying patient logs into various groups, he discovered that the situation where the patient was seen and dispositioned by only one provider, either only by the RMA (ED LOS decrease of 45%) or only by the downstream ED physician (ED LOS decrease of 9%), was superior to the one where the patient was first seen by the RMA and whose care was afterwards transitioned to the ED evaluation area physician.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies addressed adding a physician at triage—e.g. in the concept of the “triage liaison physician” (TLP)—to perform brief assessments and initiate diagnostic and treatment tasks [ 22 – 35 ]. Only few publications stratified the outcomes by patient disposition (admitted vs. discharged) or by triage levels [ 30 , 31 , 33 , 34 , 36 ].…”

Section: Introductionmentioning

confidence: 99%

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Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

et al. 2016

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Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17th 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8–66.6) to 10.2 (5.7–18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2–84.7) to 10.5 (5.9–18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1–5.3) to 3.7 (2.3–5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8–1.8) to 0.3 (0.2–0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology, anticipating that it may be better for the downstream physician to have more information rather than less.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

et al. 2016

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“…) Traub et al (2014b). study the rotational assignment of patients to physicians, finding a decrease in both LOS and LWBS.…”

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confidence: 99%

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

Saghafian

Austin

Traub

2015

IIE Transactions on Healthcare Systems Engineering

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125

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In recent years, Operations Research/Management (OR/OM) has had a significant impact on improving the performance of hospital Emergency Departments (EDs). This includes improving a wide range of processes involving patient flow from the initial call to the ED through disposition, discharge home, or admission to the hospital. We review approximately 350 related papers to (i) demonstrate the influence of OR/OM in EDs, and (ii) assist both researchers and practitioners with the OR/OM techniques already available to optimize ED patient flow. In addition, we elaborate on some practical challenges yet to be addressed. By shedding light on some less studied aspects that can have significant impacts on ED operations, we also discuss important possibilities for future OR/OM researchers.

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“…The result of such a team assignment system was notable decreases in patient wait time and LWBS (Patel and Vinson, 2005). Traub et al (2014b) study the rotational assignment of patients to physicians, finding a decrease in both LOS and LWBS. Increased satisfaction for patient waiting in DeBehnke and Decker (2002) further validates the use of patient care teams.…”

Section: Staffing and Schedulingmentioning

confidence: 99%

Operations Research Contributions to Emergency Department Patient Flow Optimization: Review and Research Prospects

2014

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Emergency Department Rapid Medical Assessment: Overall Effect and Mechanistic Considerations

Cited by 36 publications

References 29 publications

Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

Operations Research Contributions to Emergency Department Patient Flow Optimization: Review and Research Prospects

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