Senior Streaming Assessment Further Evaluation after Triage zone: A novel model of care encompassing various emergency department throughput measures

Abstract

Objective: Access block (AB) and hospital overcrowding adversely affect ED functionality. ED throughput measures have been described in the literature with positive impacts on key performance indicators (KPIs) – time to first seen, did‐not‐wait rates, off‐stretcher times for ambulances and ED length of stay figures. In this study, we aimed to assess the impact of a new model of care, the Senior Streaming Assessment Further Evaluation after Triage (SAFE‐T) zone concept on ED performance indicators and statistical outcomes. Methods: We implemented a model of care at our tertiary hospital ED amalgamating multiple ED throughput interventions. These interventions included dynamic transition waiting room concept, early senior ED physician assessment and decision‐making, early streaming, acute‐care bed quarantining and ED short stay and observation units. The principal intervention was the SAFE‐T zone. End‐point data were compared for similar periods (77 days) of 2010 and 2011 with and without the new model of care. Results: In total, 11 408 and 11 845 patients were included in the study periods pre‐ and post‐intervention, respectively. Time to physician KPI improved from 72.5% to 84.1%. Did‐not‐wait rates dropped from 10.7% to 9.6% (P= 0.02) and off‐stretcher times for ambulances KPI improved from 74.5% to 79.5% (P < 0.001). ED length of stay dropped most significantly for Australasian Triage Scale categories 3 and 4 (14.3% and 11.8%, P‐values <0.001). These results were achieved despite worsened AB and hospital bed‐occupancy rates during the intervention period (+3.9% and +6.7%). Conclusions: The SAFE‐T zone model of care involving multiple ED throughput measures achieved improvements in ED performance despite AB and hospital overcrowding.

The emergency department prediction of disposition (EPOD) study

“…9,10 Recent studies have shown positive results based on early streaming decisions as part of a multi-pronged approach. 11 Similarly, past studies have also depicted the capabilities of different emergency services in predicting the need for hospital admission. [12][13][14][15] However, no studies to date have included early streaming by senior ED doctors at triage or soon after triage to predict a patient's disposition.…”

“…1 Access block and ED overcrowding adversely affect ED functioning and the patient's length of stay (LOS) in ED. 11 Observation wards and short-stay units have added new streaming options for ED patients who require a short period of admission for clinical observation and intervention. 2 ED short-stay units have traditionally been reserved for patients who are most likely to be discharged within 24 h. Medical admission and assessment units have become commonplace in many hospitals as a conduit for medical admissions from the ED 3,4 .…”

A model of complaint based for overcrowding emergency eepartment: Five-Level Hacettepe Emergency Triage System

“…[1][2][3][4][5][6][7][8][9][10][11][12] Five-level triage systems have been commonly used in emergency departments of countries where emergency medical services have been developed. [23][24][25][26][27][28] In the United States, ESI has emerged as a new triage system in which education and experience are needed; it is the most widely used and is the most valuable of emergency triage systems.…”

“…[1][2][3][4][5][6][7][8][9] Inappropriate care areas and long durations for care in overcrowded emergency departments cause problems between patients and health care providers. [10][11][12][13][14] Different triage systems (2-Level, 3-Level, 4-Level and 5-Level) have been applied to determine the priority and management of health care for emergent patients in emergency departments.…”

Role of Video Recording in Quality Assurance of Emergency Medical Services.

“…The rationale for restructuring is first and foremost to cope with an increased amount of patients while securing delivery of high quality and efficiency, concurrently with decreased overall hospital capacity 3 . Promotion of interdisciplinary teamwork and earlier senior physician involvement are examples of means to deliver timely and high quality treatment to patients within the EDs, which is essential for early diagnosis and provision of effective treatment of the increasing number of patients with co morbidities 4,5 . Other prevalent changes include introducing emergency medicine as a separate specialty 6 and formalized use of triage systems 7 .…”