Team triage improves emergency department efficiency

Subash, F.; Dunn, FG; McNicholl, B; Marlow, Jeff

doi:10.1136/emj.2002.003665

Cited by 120 publications

(89 citation statements)

References 5 publications

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“…Team-training exercises for health care professionals are considered to be a highly effective tool to improve communication and team performance, particularly in crisis situations. [8][9][10] TeamSTEPPS, developed by the Department of Defense and the AHRQ, is an evidence-based framework to optimize team performance across the health care delivery system. 11,12 The framework comprises 4 teaching and learning skills: (1) leadership, (2) situation monitoring, (3) mutual support, and (4) communication.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training

Maxson

Dozois

Holubar

et al. 2011

Mayo Clinic Proceedings

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N early a decade has passed since the Institute of Medicine released its seminal report To Err is Human: Building a Safer Health System. 1 The report described the US health care system as a decade or more behind other high-risk industries in its attention to ensuring basic safety. One recommendation was that Congress should create a center for patient safety within the Agency for Healthcare Research and Quality (AHRQ). The AHRQ was asked to set standards, communicate with members about safety, and develop training programs that create a culture of safety across disciplines. 1 The AHRQ supports simulation research through its patient safety program, recognizing that "simulation in health care creates a safe learning environment that allows researchers and practitioners to test new clinical processes and to enhance individual and team skills before encountering patients." 2 OBJECtIvE: To determine whether interdisciplinary simulation team training can positively affect registered nurse and/or physician perceptions of collaboration in clinical decision making.PARtICIPANtS AND MEtHODS: Between March 1 and April 21, 2009, a convenience sample of volunteer nurses and physicians was recruited to undergo simulation training consisting of a team response to 3 clinical scenarios. Participants completed the Collaboration and Satisfaction About Care Decisions (CSACD) survey before training and at 2 weeks and 2 months after training. Differences in CSACD summary scores between the time points were assessed with paired t tests.RESuLtS: Twenty-eight health care professionals (19 nurses, 9 physicians) underwent simulation training. Nurses were of similar age to physicians (27.3 vs 34.5 years; p=.82), were more likely to be women (95.0% vs 12.5%; p<.001), and were less likely to have undergone prior simulation training (0% vs 37.5%; p=.02). The pretest showed that physicians were more likely to perceive that open communication exists between nurses and physicians (p=.04) and that both medical and nursing concerns influence the decision-making process (p=.02). Pretest CSACD analysis revealed that most participants were dissatisfied with the decisionmaking process. The CSACD summary score showed significant improvement from baseline to 2 weeks (4.2 to 5.1; p<.002), a trend that persisted at 2 months (p<.002). CONCLuSION:Team training using high-fidelity simulation scenarios promoted collaboration between nurses and physicians and enhanced the patient care decision-making process. Effective collaboration between registered nurses and physicians has been shown to reduce morbidity and mortality rates, cost of care, and medical errors and to improve job satisfaction and retention of nursing staff. [3][4][5][6] The nursing workforce is expected to decrease by 20% by 2020, putting the profession in a critical shortage. 7 Collaboration between nurses and physicians improves professional job satisfaction and is considered a high priority for retention purposes. The literature has outlined the importance of nurse-physician collaboration b...

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Section: Discussionmentioning

confidence: 99%

Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training

Maxson

Dozois

Holubar

et al. 2011

Mayo Clinic Proceedings

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“…In three similar models to the research site, Han et al [4] , Partovi et al [5] , and Holroyd et al [6] showed a reduction in overall LOS and number of patients leaving without being seen (LWBS). In two studies from the United Kingdom, Terris et al [7] noted a reduction in number of patients waiting to be seen at any one time utilizing a physician in triage while Subash et al [10] showed that team triage for three hours a day reduced time to see a doctor and time to radiology during the time of intervention but not for the remainder of the day. Finally, in a study from Hong Kong, Choi et al [8] showed a reduction in mean waiting time and mean processing time by moving a faculty to triage without additional staffing.…”

Section: Discussionmentioning

confidence: 99%

“…studies in the literature that have investigated the use of a physician in triage [4][5][6][7][8][9][10][11][12] . The majority of these studies have focused on patient flow metrics for measured outcomes.…”

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confidence: 99%

Improving patient satisfaction by adding a physician in triage

Imperato

Morris

Sánchez

et al. 2013

JHA

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Background: The physician in triage (PIT) model has been proposed as a process improvement to help increase efficiency in the Emergency Department setting. However, its effect on patient satisfaction has not been well established.Methods: An interventional study comparing patient satisfaction scores for the 6-month period before and after implementation of a physician in triage model. In our system an additional attending physician was assigned to triage from 1 p.m. to 9 p.m. daily. Outcome measures were mean scores obtained from respondents to Press Ganey® patient satisfaction surveys for selected questions most likely to be impacted by PIT implementation and those included in the physician section of the survey.Results: Five hundred and eight respondents seen in the six months before the initiation of the PIT team and 458 respondents in the six months after the system change were included in the study. Improvement was noted in the absolute Press Ganey® scores in the Post-PIT time period across all questions analyzed with statistically significant differences noted for 8 of the 10 questions studied. Conclusions:Although seemingly small there was a statistically significant improvement in the absolute patient satisfaction scores after adding a physician in triage. Because small gains in absolute scores can result in large improvements on the percentile rank when using Press Ganey® surveys, physician in triage may be of significant benefit to overall patient satisfaction.

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“…However, previous studies have shown that physician triage improves ED LOS and may bias our findings toward an improvement in ambulance diversion and ED LOS. [21][22][23] Physician triage may also explain why our left-without-being-seen rates decreased slightly. 21 Our study did not account for seasonal variation.…”

Section: Limitationsmentioning

confidence: 99%

The Effect of Emergency Department Expansion on Emergency Department Overcrowding

Han

Zhou

Sheng

et al. 2007

Academic Emergency Medicine

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Objectives: To examine the effects of emergency department (ED) expansion on ambulance diversion at an urban, academic Level 1 trauma center.Methods: This was a pre-post study performed using administrative data from the ED and hospital electronic information systems. On April 19, 2005, the adult ED expanded from 28 to 53 licensed beds. Data from a five-month pre-expansion period (November 1, 2004, to March 1, 2005) and a five-month postexpansion period (June 1, 2005, to October 31, 2005 were included for this analysis. ED and waiting room statistics as well as diversion status were obtained. Total ED length of stay (LOS) was defined as the time from patient registration to the time leaving the ED. Admission hold LOS was defined as the time from the inpatient bed request to the time leaving the ED for admitted patients. Mean differences (95% confidence interval [CI]) in total time spent on ambulance diversion per month, diversion episodes per month, and duration per diversion episode were calculated. An accelerated failure time model was performed to test if ED expansion was associated with a reduction in ambulance diversion while adjusting for potential confounders.Results: From pre-expansion to postexpansion, daily patient volume increased but ED occupancy decreased. There was no significant change in the time spent on ambulance diversion per month (mean difference, 10.9 hours; 95% CI = À74.0 to 95.8), ambulance diversion episodes per month (two episodes per month; 95% CI = À4.2 to 8.2), and duration of ambulance diversion per episode (0.3 hours; 95% CI = À4.0 to 3.5). Mean (AESD) total LOS increased from 4.6 (AE1.9) to 5.6 (AE2.3) hours, and mean (AESD) admission hold LOS also increased from 3.0 (AE0.2) to 4.1 (AE0.2) hours. The proportion of patients who left without being seen was 3.5% and 2.7% (p = 0.06) in the pre-expansion and postexpansion periods, respectively. In the accelerated failure time model, ED expansion did not affect the time to the next ambulance diversion episode.Conclusions: An increase in ED bed capacity did not affect ambulance diversion. Instead, total and admission hold LOS increased. As a result, ED expansion appears to be an insufficient solution to improve diversion without addressing other bottlenecks in the hospital.

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Team triage improves emergency department efficiency

Cited by 120 publications

References 5 publications

Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training

Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training

Improving patient satisfaction by adding a physician in triage

The Effect of Emergency Department Expansion on Emergency Department Overcrowding

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