Holroyd Brian R, Bullard Michael J, Latoszek Karen, Gordon Debbie, Allen Sheri, Tam Siulin, Blitz Sandra, Yoon Philip, Rowe Brian H
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Acad Emerg Med. 2007 Aug;14(8):702-8. doi: 10.1197/j.aem.2007.04.018.
Triage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear.
To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting.
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.
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.
A TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs.
分流联络医师（TLPs）已被应用于过度拥挤的急诊科（EDs）；然而，其有效性仍不明确。
采用综合结果报告评估在一所学术性三级成人急诊科实施TLPs轮班的情况。
2005年12月9日至2006年2月9日开展了一项为期六周的TLPs临床研究项目。每天安排一名TLPs工作9小时（上午11点至晚上8点），负责启动患者管理、协助分诊护士、接听所有医疗咨询或转诊电话以及处理急诊科行政事务。该研究分为三个为期两周的时间段；在每个时间段内，七天随机安排TLPs轮班，另外七天为对照轮班。结果包括患者住院时间、未接受完整评估即离开的患者比例、工作人员满意度以及救护车分流事件。
TLPs每班评估的患者中位数为14名（四分位间距，13 - 17），每班接听15个电话（四分位间距，14 - 20），每班电话咨询花费17 - 81分钟。TLPs轮班和对照轮班期间的患者数量及其年龄、性别和分诊分数相似。总体而言，与对照日相比，住院时间缩短了36分钟（4小时21分对4小时57分；p = 0.001）。在TLPs值班期间，未接受完整评估即离开的病例从6.6%降至5.4%（相对下降20%）。TLPs轮班日和对照日的救护车等待时间及救护车分流事件数量相似。
TLPs改善了过度拥挤急诊科的重要结果，并且可能改善类似三级急诊科的紧急医疗服务提供情况。
