Li Joyce, Caviness Alison C, Patel Binita
Department of Pediatric Emergency Medicine, Harvard Medical School, Children's Hospital Boston, Boston, MA 02116, USA.
Pediatr Emerg Care. 2011 Aug;27(8):687-92. doi: 10.1097/PEC.0b013e318226c7b2.
This study aimed to determine the impact of a triage team on patient length of stay (LOS) overall and by patient acuity in a pediatric emergency department (ED).
We conducted a cluster randomized controlled trial in which existing ED staffing was reallocated to include a triage team. The study was conducted in an urban children's ED Monday through Friday, from 6:00 P.M. to 2:00 A.M., for 4 weeks in February 2008. Twenty study periods were randomized according to the absence or presence of a triage team (physician, nurse, and nurse assistant) that initiated evaluations of nonurgent and urgent patients. We compared patient LOS between study periods with and without triage teams, using generalized estimating equations to allow for the clustering of effects by day.
Of the 1726 patients, 843 were seen during nontriage team times and 883 during triage team times. Overall, there was a 21-minute decrease in LOS during triage team times compared with nontriage team times, but this was not statistically significant. Stratifying by patient acuity level, LOS was significantly decreased during triage team times for nonurgent (25 minutes, P = 0.001) and urgent patients (50 minutes, P = 0.047) but prolonged for emergent patients (79 minutes, P = 0.019) and unchanged for critically ill patients.
Overall, although we did not find a statistically significant decrease in the LOS with the use of a dedicated triage team, we did find statistically significant decreases in the stratified analysis for urgent, nonurgent patient, and discharged patients. An important reason statistical significance may not have been reached in this study may have been our hospital's current staffing model, and therefore, the use of a triage team as additional staffing versus reallocation of existing staffing may depend on an institution's current level of staffing and its ability to meet patient demand.
本研究旨在确定分诊团队对儿科急诊科患者总体住院时间（LOS）以及按患者 acuity 分类的住院时间的影响。
我们进行了一项整群随机对照试验，将现有的急诊科人员重新分配以纳入一个分诊团队。该研究于 2008 年 2 月的周一至周五晚上 6 点至凌晨 2 点在一家城市儿童急诊科进行，为期 4 周。根据是否存在启动对非紧急和紧急患者评估的分诊团队（医生、护士和护士助理），将 20 个研究时段随机分组。我们使用广义估计方程来考虑按天聚类的效应，比较了有和没有分诊团队的研究时段之间的患者住院时间。
在 1726 名患者中，843 名在非分诊团队时段就诊，883 名在分诊团队时段就诊。总体而言，与非分诊团队时段相比，分诊团队时段的住院时间减少了 21 分钟，但这在统计学上并不显著。按患者 acuity 水平分层，分诊团队时段非紧急患者（25 分钟，P = 0.001）和紧急患者（50 分钟，P = 0.047）的住院时间显著减少，但急诊患者延长（79 分钟，P = 0.019），重症患者不变。
总体而言，虽然我们没有发现使用专门的分诊团队使住院时间有统计学上的显著减少，但我们在对紧急、非紧急患者和出院患者的分层分析中确实发现了统计学上的显著减少。本研究可能未达到统计学显著性的一个重要原因可能是我们医院目前的人员配备模式，因此，使用分诊团队作为额外人员配备还是重新分配现有人员配备可能取决于机构目前的人员配备水平及其满足患者需求的能力。
