Improvement in emergency department length of stay using an early senior medical assessment and streaming model of care: A cohort study

Abstract

Objective : Australian EDs are required to conform to the National Emergency Access Target (NEAT): patients must be discharged within 4 h of arrival. The aim of the present study was to determine if a model of care called Senior Assessment and Streaming (SAS) would increase the proportion of patients achieving NEAT. Methods:Stable, ambulant patients considered to have problems that early consultant-level assessment was likely to improve processing efficiency were streamed through a dedicated clinical area staffed by an ED physician, intern and nurse. The proportion of patients achieving NEAT were compared between days with or without SAS, adjusted for confounding variables. Results:The 18 962 patients presented during the study, 6828 on days with SAS, 12 134 on days without. On days with SAS, there were more presentations, more admissions, lower access to ward beds and fewer staff working hours. After controlling for confounding, the odds of meeting NEAT on days with SAS was 15% higher compared with days without (odds ratio, 1.15; 95% confidence interval [CI], 1.07-1.24; P < 0.001). For the subgroups of patients admitted, discharged, triage category 3, 4, 5, or presentation 12.00-18.00 the odds of meeting NEAT on days with SAS was, respectively, 1.10 (95% CI, 0.98-1.23; P = 0.10), 1.17 (95% CI, 1.07-1.28; P < 0.001), 1.17 (95% CI, 1.08-1.27; P < 0.001) and 1.19 (95% CI, 1.06-1.35; P = 0.003). The odds of a patient not waiting to be seen on days with SAS was 28% lower compared with days without (odds ratio, 0.72; 95% CI, 0.58-0.90; P = 0.003). Conclusion:Through the introduction of SAS, the present study has demonstrated that providing early senior medical assessment can improve an ED's ability to meet NEAT.

The impact of senior doctor assessment at triage on emergency department performance measures: systematic review and meta-analysis of comparative studies

“…In the final group of 15 studies, the intervention was a senior doctor-led team triage where the senior doctor was accompanied by a team of other health professionals such as nurses and technicians. In five of these studies, the team included junior doctors in addition to nurses or technicians 24 31 32 36 37. See table 1.…”

“…Using the EPHPP global rating decision tool, 4 studies were assessed as being of strong quality,23 34 35 37 9 of moderate quality18 20 25 26 27 29 31 32 39 and 12 of weak quality. None of the studies were double blinded.…”

“…High heterogeneity did not allow pooled estimates to be provided. All non-RCTs except three16 17 31 were associated with a significant reduction in LOS with a median decrease of 26 min (IQR −6 to −56) (figure 1). …”

Evaluation of fast track strategies using agent-based simulation modeling to reduce waiting time in a hospital emergency department

“…Different methods have been proposed based on the fast track concept, such as using functional principles to separate patients into streams on the basis of complexity rather than acuity [12]; separating high-and low-variability patients to improve throughput and reduce LOS in ED [30]; and improving ED LOS using an early senior medical assessment and streaming model of care [31].…”

Elder-friendly emergency services in Brazil: necessary conditions for care

“…The experiences described by care programs have demonstrated that, through appropriate geriatric assessments, identification of risks, and support strategies in the transition of the care, it is possible to reduce the return of the elderly to the ES, avoid admissions, obtain greater satisfaction, and reduce hospital costs (5,16,(18)(19) . Therefore, these studies offer different examples that can encourage new practices in the ES together with the reality of each institution.…”