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

Abdulwahid, Maysam; Booth, Andrew; Kuczawski, Maxine; Mason, Suzanne

doi:10.1136/emermed-2014-204388

Cited by 86 publications

(66 citation statements)

References 43 publications

(110 reference statements)

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“…Both of these studies occurred in Canada, however, where delivery care might be diferent than other setings, thus limiting their generalizability [51,52]. Two other randomized controlled trials demonstrated no afect of physician in triage on LOS [50].…”

Section: Improving Emergency Department Patient Throughputmentioning

confidence: 99%

“…A systemic review of triage nurses ordering radiographs has demonstrated nearly a 20-min decrease in patient LOS with implementation of triage nursing orders [49]. Studies have suggested that having an advanced practitioner or a physician in triage may reduce the ED LOS and rates of leaving without being seen [45,50]. Two randomized trials of physician in triage demonstrated reduced patient LOS by 36 min in one study (12% reduction) [51], and 122 min in the other (35% reduction) [52].…”

Section: Improving Emergency Department Patient Throughputmentioning

confidence: 99%

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Overcrowding in the Emergency Department and Patient Safety

Jeanmonod¹,

Jeanmonod²

2018

Vignettes in Patient Safety - Volume 2

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Emergency department (ED) overcrowding is a recognized problem worldwide. This chapter reviews the scope of the problem, manifestations, repercussions, and potential solutions to this problem.Keywords: emergency department overcrowding, emergency department safety, emergency department systems, emergency department patient care, emergency department throughput, emergency department output A 68-year-old Case vignete

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Section: Improving Emergency Department Patient Throughputmentioning

confidence: 99%

Section: Improving Emergency Department Patient Throughputmentioning

confidence: 99%

Overcrowding in the Emergency Department and Patient Safety

Jeanmonod¹,

Jeanmonod²

2018

Vignettes in Patient Safety - Volume 2

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“…Triage liaison physicians were reported to have had an impact in reducing ED lengths of stay, compared with nurse-led triage, 219 and senior doctor triage could reduce both waiting times and length of stay in the ED. 204 Three reviews assessed the evidence on use of observation or assessment units and short-stay wards. One concluded that assessment or observation units had potential to produce benefits, including facilitating early senior clinician involvement and reducing length of stay and inappropriate admissions, but that this may only apply to specific diagnostic groups.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…In the absence of a risk of bias assessment, it is more difficult to assess the strength of the evidence underlying the review's conclusions. Seventeen reviews 204,205,[207][208][209][210][211][212][213][215][216][217][218][219][220]222,224 were judged to have used an appropriate method to synthesise the studies. In most cases a narrative approach was used because the included studies were too heterogeneous for meta-analysis.…”

Section: Qualitymentioning

confidence: 99%

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Acute assessment services for patient flow assistance in hospital emergency departments

Shaw

Parsons

et al. 2021

Cochrane Database of Systematic Reviews

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

Abstract: This review demonstrates that SDT can be an effective measure to enhance ED performance, although cost versus benefit analysis is needed. The potential high risk of bias in the evidence identified, however, mandates more robust multicentred studies to confirm these findings.

Cited by 86 publications

References 43 publications

Overcrowding in the Emergency Department and Patient Safety

Overcrowding in the Emergency Department and Patient Safety

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Acute assessment services for patient flow assistance in hospital emergency departments

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