Interprofessional teamwork versus fast track streaming in an emergency department—An observational cohort study of two strategies for enhancing the throughput of orthopedic patients presenting limb injuries or back pain

Abstract

Objective To compare two strategies, interprofessional teams versus fast track streaming, for orthopedic patients with limb injuries or back pain, the most frequent orthopedic complaints in an emergency department. Methods An observational before-and-after study at an adult emergency department from May 2012 to Nov 2015. Patients who arrived on weekdays from 8 am to 9 pm and presented limb injury or back pain during one year of each process were included, so that 11,573 orthopedic presentations were included in the fast track period and 10,978 in the teamwork period. Similarly, another 11,020 and 10,760 arrivals presenting the six most frequent non-orthopedic complaints were included in the respective periods, altogether 44,331 arrivals. The outcome measures were the time to physician (TTP) and length of stay (LOS). The LOS was adjusted for predictors, including imaging times, by using linear regression analysis. Results The overall median TTP was shorter in the teamwork period, 76.3 min versus 121.0 min in the fast track period (-44.7 min, 95% confidence interval (CI): -47.3 to -42.6). The crude median LOS for orthopedic presentations was also shorter in the teamwork period, 217.0 min versus 230.0 min (-13.0 min, 95% CI: -18.0 to -8.0), and the adjusted LOS was 22.8 min shorter (95% CI: -26.9 to -18.7). For non-orthopedic presentations, the crude median LOS did not differ significantly between the periods (2.0 min, 95% CI: -3.0 to 7.0). However, the adjusted LOS was shorter in the teamwork period (-20.1 min, 95% CI: -24.6 to -15.7). Conclusions The median TTP and LOS for orthopedic presentations were shorter in the teamwork period. For non-orthopedic presentations, the TTP and adjusted LOS were also shorter in the teamwork period. Therefore, interprofessional teamwork may be an alternative approach to improve the patient flow in emergency departments.

Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study

“…However, they did not have a standardized approach to evaluate the older patients, for example, with regard to fall risk or cognitive function. The interprofessional work process was otherwise similar in the geriatric module and the regular ED during both periods and has been described in our previous studies [35,37]. All patients 80 years or older were eligible for the geriatric module, but younger patients 65 to 79 years old with comorbidities could also be accepted by the geriatric team.…”

The therapeutic management of back pain with and without sciatica in the emergency department: a systematic review

“…Adverse effect: G2 2: 34% (95%CI 22-46) vs G1 64% (95%CI 52-76) p=0.0005. Kocak 30mins: Pain VAS: Median changes: G1 54mm (95% CI=50-60mm), G2 29mm (95% CI=28-34mm), G3 12.5mm (95% CI [10][11][12][13][14][15].…”

“…The importance of establishing some recommendations for the management of low back pain with or without sciatica in the absence of clinical red flags or serious pathology in the ED would be helpful to patients and clinicians. A MDT approach to health care is becoming increasingly commonplace and there is a growing body of evidence suggesting that inter-professional teamwork in the ED could be beneficial in reducing LOS and unnecessary imaging (8)(9)(10).…”

Evaluation of interprofessional teamwork modules implementation in an emergency department – A mixed-methods case study of implementation fidelity

“…Collaborative practice of health professionals is needed since medical errors are correlated to failures of teamwork and communication, while effective teamwork improves outcomes in healthcare [ 5 ]. Studies of interprofessional teamwork including teamwork training in emergency department (ED) settings have reported reduced error rates, reduced waiting times to physician assessment, shorter ED lengths of stay, and improved patient and staff satisfaction [ 6 – 12 ].…”

“…This study is part of a mixed-methods evaluation of the implementation of interprofessional teamwork in a large ED, which was reorganized into teamwork modules with integrated triage of patients instead of a separate triage section. We have previously reported improved patient waiting time and ED length of stay during the first year after the implementation of interprofessional teamwork modules [ 11 , 12 ], while in this study we evaluated the implementation process over a period of nearly 5 years by using data from the health professionals. The aim was to examine the degree of fidelity to the teamwork implementation and explore the experiences of health professionals to answer our research questions: Was the implementation fidelity sustained?…”