Use of Physician-in-Triage Model in the Management of Abdominal Pain in an Emergency Department Observation Unit

Abstract

IntroductionGiven the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission).MethodsThis was a retrospective cohort study of patients admitted to a protocol-driven EDOU with a diagnosis of abdominal pain in a single university hospital center ED. We obtained compiled data for all patients admitted to the EDOU with a diagnosis of abdominal pain that met EDOU protocol admission criteria. We divided data for each cohort into age, gender, payer status, and LOS. The data were then analyzed to assess any significant differences between the cohorts.ResultsA total of 327 patients were eligible for this study (85 triage group, 242 main ED group). The total success rate was 90.8% (n=297) and failure rate was 9.2% (n=30). We observed no significant differences in success rates between those dispositioned to the EDOU by triage physicians (90.6%) and those via the traditional route (90.5 % p) = 0.98. However, we found a significant difference between the two groups regarding total LOS with significantly shorter main ED times and EDOU times among patients sent to the EDOU by the physician-in-triage group (p< .001).ConclusionThere were no significant differences in EDOU disposition outcomes in patients admitted to an EDOU by a physician-in-triage or via the traditional route. However, there were statistically significant shorter LOSs in patients admitted to the EDOU by triage physicians. The data from this study support the implementation of a physician-in-triage model in combination with the EDOU in improving efficiency in the treatment of abdominal pain. This knowledge may spur action to cut healthcare costs and improve patient flow and timely decision-making in hospitals with EDOUs.

Emergency department observation of mild traumatic brain injury with minor radiographic findings: shorter stays, less expensive, and no increased risk compared to hospital admission

“…1 7 These units, often staffed with a midlevel practitioner and supervised by ED attending staff, were originally developed to monitor patients presenting with chest pain but low clinical probability of myocardial infarction, with the goal of using fewer resources than the analogous admission to a cardiac ICU. 8 Subsequent data have shown that EDOUs can reduce inpatient admission rate, length of stay, and cost for a wide variety of acute medical problems [9][10][11][12][13][14] and the Institute of Medicine has concluded that EDOUs can reduce unwarranted hospitalizations and improve institutional patient flow. 15 Despite this, few studies have evaluated EDOU protocols for acute neurological presentations.…”

Die Abdominal Pain Unit als Behandlungspfad

“…Nicht nur aufgrund des demographischen Wandels mit einem steigenden Anteil der älteren Bevölkerung [4,17], sondern auch aufgrund des vermehrten Patientenaufkommens in den Notaufnahmen [10,11] müssen die aktuellen Versorgungsstrukturen kritisch evaluiert werden. Die NA als intersektorale Schnittstelle muss stationären und ambulanten Qualitätsanforderungen gerecht werden, somit ist die einheitliche Qualitätsdokumentation und -messung in der Notfallmedizin anzustreben [8].…”