Triaging Inpatient Admissions: an Opportunity for Resident Education

Abstract

In the context of internal medicine, Btriage^is a newly popularized term that refers to constellation of activities related to determining the most appropriate disposition plans for patients, including assessing patients for admissions into the inpatient medicine service. The physician or Btriagist^plays a critical role in the transition of care from the outpatient to the inpatient settings, yet little literature exists addressing this particular transition. The importance of this set of responsibilities has evolved over time as health systems become increasingly complex to navigate for physicians and patients. With the emphasis on hospital efficiency metrics such as emergency department throughput and appropriateness of admissions, this type of systems-based thinking is a necessary skill for practicing contemporary inpatient medicine. We believe that triaging admissions is a critical transition in the care continuum and represents an entrustable professional activity that integrates skills across multiple Accreditation Council for Graduate Medical Education (ACGME) competencies that internal medicine residents must master. Specific curricular competencies that address the domains of provider, system, and patient will deliver a solid foundation to fill a gap in skills and knowledge for the triagist role in IM residency training.

Quantifying the Risks of Hospitalization—Is It Really as Safe as We Believe?

“…Graduate medical education now identifies the triage process as a specific milestone within the transitions of care competency, as it requires mastery of interpersonal communication, professionalism, systems-based thinking, and patient-centered care. 2 However, many institutions lack a dedicated faculty member to perform the triage role. Our institution recently examined the feasibility of instituting a daily "huddle" between the admitting hospitalist and the ED to facilitate interdepartmental communication to create care plans in patient triage and to promote patient throughput.…”

Exploring the Intersections of Education and Healthcare Delivery Using a Clinical Learning Environment Framework

“…Wang and colleagues identified the emerging Btriagist^role as an underutilized opportunity to purposefully align the goals of healthcare delivery and education. 9 Although the role was primarily created to improve delivery system performance metrics such as appropriate use of hospital resources and efficient flow of patients from the emergency department to inpatient services, the authors recognized an untapped and potentially high-value learning opportunity for residents if some of the work of triagists could be shifted from staff physicians to trainees and structured to provide sufficient support and supervision. Wang and colleagues implicitly illustrate the value of a clinical learning environment analysis that ties together clinical service goals and educational goals.…”

Qualitative analysis of disposition decision making for patients referred for admission from the emergency department without definite medical acuity

“…Additionally, most of the current literature focuses on ED physician perspective even as internal medicine trained hospitalists increasingly serve in the role of 'triage physician' providing an inpatient-based acute care screening and approval for admissions. 30 31 We propose that hospitalists can provide a useful vantage point from which to learn more about this phenomenon.…”