BACKGROUND: Triage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear. OBJECTIVES: To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting. METHODS: A six-week TLP clinical research project was conducted between December 9, 2005, and February 9, 2006. A TLP was deployed for nine hours (11 AM to 8 PM) daily to initiate patient management, assist triage nurses, answer all medical consult or transfer calls, and manage ED administrative matters. The study was divided into three two-week blocks; within each block, seven days were randomized to TLP shifts and the other seven to control shifts. Outcomes included patient length of stay, proportion of patients who left without complete assessment, staff satisfaction, and episodes of ambulance diversion. RESULTS: TLPs assessed a median of 14 patients per shift (interquartile range, 13-17), received 15 telephone calls per shift (interquartile range, 14-20), and spent 17-81 minutes per shift consulting on the telephone. The number of patients and their age, gender, and triage score during the TLP and control shifts were similar. Overall, length of stay was decreased by 36 minutes compared with control days (4:21 vs. 4:57; p = 0.001). Left without complete assessment cases decreased from 6.6% to 5.4% (a 20% relative decrease) during the TLP coverage. The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days. CONCLUSIONS: A TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs.
RCT Entities:
BACKGROUND: Triage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear. OBJECTIVES: To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting. METHODS: A six-week TLP clinical research project was conducted between December 9, 2005, and February 9, 2006. A TLP was deployed for nine hours (11 AM to 8 PM) daily to initiate patient management, assist triage nurses, answer all medical consult or transfer calls, and manage ED administrative matters. The study was divided into three two-week blocks; within each block, seven days were randomized to TLP shifts and the other seven to control shifts. Outcomes included patient length of stay, proportion of patients who left without complete assessment, staff satisfaction, and episodes of ambulance diversion. RESULTS: TLPs assessed a median of 14 patients per shift (interquartile range, 13-17), received 15 telephone calls per shift (interquartile range, 14-20), and spent 17-81 minutes per shift consulting on the telephone. The number of patients and their age, gender, and triage score during the TLP and control shifts were similar. Overall, length of stay was decreased by 36 minutes compared with control days (4:21 vs. 4:57; p = 0.001). Left without complete assessment cases decreased from 6.6% to 5.4% (a 20% relative decrease) during the TLP coverage. The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days. CONCLUSIONS: A TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs.
Authors: David M Nestler; Alesia R Fratzke; Christopher J Church; Lori Scanlan-Hanson; Annie T Sadosty; Michael P Halasy; Janet L Finley; Andy Boggust; Erik P Hess Journal: Acad Emerg Med Date: 2012-11 Impact factor: 3.451
Authors: Emily S Wang; Sadie Trammell Velásquez; Christopher J Smith; Tabatha H Matthias; David Schmit; Sherwin Hsu; Luci K Leykum Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Jason Imperato; Darren Scott Morris; David Binder; Christopher Fischer; John Patrick; Leon Dahomey Sanchez; Gary Setnik Journal: Intern Emerg Med Date: 2012-08-03 Impact factor: 3.397
Authors: David M Nestler; Michael P Halasy; Alesia R Fratzke; Christopher J Church; Lori N Scanlan-Hanson; Christine M Lohse; Ronna L Campbell; Annie T Sadosty; Erik P Hess Journal: Acad Emerg Med Date: 2014-06-10 Impact factor: 3.451
Authors: Brian J Franklin; Kathleen Y Li; David M Somand; Keith E Kocher; Steven L Kronick; Vikas I Parekh; Eric Goralnick; A Tyler Nix; Nathan L Haas Journal: J Am Coll Emerg Physicians Open Date: 2021-05-24