Placing Physician Orders at Triage: The Effect on Length of Stay - 20/08/11
, Ian Jones, MD a, Dominik Aronsky, MD, PhD a, b, Robert S. Dittus, MD, MPH c, d, Corey M. Slovis, MD a
Address for correspondence: Stephan Russ, MD, MPH, Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232-4700; 615-936-1160, fax 615-936-1316Résumé |
Study objective |
Emergency department (ED) crowding is a significant problem nationwide, and numerous strategies have been explored to decrease length of stay. Placing a physician in the triage area to rapidly disposition low-acuity patients and begin evaluations on more complex patients is one strategy that can be used to lessen the effect of ED crowding. The goal of this study is to assess the effect of order placement by a triage physician on length of stay for patients ultimately treated in a bed within the ED.
Methods |
We conducted a pre-experimental study with retrospective data to evaluate patients with and without triage physician orders at a single academic institution. A matched comparison was performed by pairing patients with the same orders and similar propensity scores. Propensity scores were calculated with demographic and triage data, chief complaint, and ED capacity on the patient's arrival.
Results |
During the 23-month study period, a total of 66,909 patients were sent to the waiting room after triage but still eventually spent time in an ED bed. A quarter of these patients (23%) had physician orders placed at triage. After a matched comparison, patients with triage orders had a 37-minute (95% confidence interval 34 to 40 minutes) median decrease in time spent in an ED bed, with an 11-minute (95% confidence interval 7 to 15 minutes) overall median increase in time until disposition.
Conclusion |
Our study suggests that early orders placed by a triage physician have an effect on ED operations by reducing the amount of time patients spend occupying an ED bed.
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| Please see page 28 for the Editor's Capsule Summary of this article. |
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| Provide process.asp?qs_id=5693 on this article at the journal's Web site, www.annemergmed.com. |
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| Supervising editor: Donald M. Yealy, MD |
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| Author contributions: SR and RSD conceived and designed the study. SR performed the data analysis and statistics and drafted the initial article. IJ and DA created the data collection systems. IJ, DA, and CMS contributed substantially to data collection systems revision. IJ and CMS implemented the described intervention. SR takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Russ was supported by the Department of Veterans Affairs Office of Academic Affiliations, with resources of the VA–Tennessee Valley Healthcare System, Nashville, TN. |
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| Publication date: Available online March 16, 2010. |
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| Reprints not available from the authors. |
Vol 56 - N° 1
P. 27-33 - juillet 2010 Retour au numéro
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