Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN.
Acad Emerg Med. 2014 Jul;21(7):794-8. doi: 10.1111/acem.12416. Epub 2014 Jun 10.
Patient throughput is an increasingly important cause of emergency department (ED) crowding. The authors previously reported shorter patient length of stay (LOS) when adding a triage liaison provider, which required additional personnel. Here, the objective was to evaluate the effect of moving a fast-track provider to the triage liaison role.
This was a prospective observational before-and-after study design with predefined outcomes measures. A "standard staffing" situation (where an advanced practice provider staffed treatment rooms in the fast track) was compared with an advanced practice provider performing the triage liaison staffing role, with no additional staff. Eleven intervention ("triage liaison staffing") days were compared with 11 matched control ("standard staffing") days immediately preceding the intervention. Total LOS was measured for all adult Emergency Severity Index (ESI) 3, 4, and 5 patients (excluding behavioral health patients), and results were compared using Wilcoxon rank-sum and chi-square tests.
A total of 681 patients registered on control days and 599 on intervention days. There was no significant difference in total patient LOS: median = 273 minutes, interquartile range (IQR) 176 to 384 minutes on intervention days versus median = 253 minutes, IQR = 175 to 365 minutes on control days (p = 0.20). There was no difference in left-without-being-seen (LWBS) rates (n = 48, 7% on control days vs. n = 35, 6% on intervention days; p=0.38). Secondary analysis of only ESI 3 patients showed no difference in total LOS between periods (median = 284 minutes, IQR = 194 to 396 minutes on intervention days vs. median = 290 minutes, IQR = 217 to 397 minutes on control days; p = 0.22). There was, however, significantly greater total LOS for ESI 4 and 5 patients during the intervention period (median = 238 minutes, IQR = 124 to 350 minutes on intervention days vs. median = 192 minutes, IQR = 124 to 256 minutes on control days; p = 0.011).
The previously reported benefits on patient LOS and LWBS rates after adding a triage liaison (resource additive) were lost when that provider was moved from fast track to the triage role (resource neutral). While the triage liaison provider role may be a way to improve ED throughput when additional resources are available, as evidenced by our prior study, the triage liaison model itself does not appear to replace the staffing of treatment rooms, as evidenced by this study.
患者吞吐量是急诊科（ED）拥堵日益重要的原因。作者之前报告说，当增加分诊联络员时，患者的住院时间（LOS）会缩短，但这需要额外的人员。在这里，目的是评估将快速通道提供者转移到分诊联络员角色的效果。
这是一项前瞻性观察性前后研究设计，有预设的结果测量。将“标准人员配备”情况（高级实践提供者在快速通道中为治疗室配备人员）与高级实践提供者执行分诊联络员人员配备角色进行比较，不增加其他人员。将 11 个干预（“分诊联络员人员配备”）日与干预前的 11 个匹配对照（“标准人员配备”）日进行比较。对所有成人急诊严重程度指数（ESI）3、4 和 5 患者（不包括行为健康患者）的总 LOS 进行测量，并使用 Wilcoxon 秩和和卡方检验比较结果。
共有 681 名患者在对照日登记，599 名患者在干预日登记。总患者 LOS 无显著差异：中位数=273 分钟，IQR=176 至 384 分钟，干预日与中位数=253 分钟，IQR=175 至 365 分钟，对照日（p=0.20）。无留观率（LWBS）差异（n=48，对照日 7%，干预日 35，6%；p=0.38）。仅对 ESI 3 患者的二次分析显示，两个时期的总 LOS 无差异（中位数=284 分钟，IQR=194 至 396 分钟，干预日与中位数=290 分钟，IQR=217 至 397 分钟，对照日；p=0.22）。然而，干预期间 ESI 4 和 5 患者的总 LOS 显著增加（中位数=238 分钟，IQR=124 至 350 分钟，干预日与中位数=192 分钟，IQR=124 至 256 分钟，对照日；p=0.011）。
在增加分诊联络员（资源附加）后，患者 LOS 和 LWBS 率的先前报告的益处在将该提供者从快速通道转移到分诊角色时丢失（资源中性）。虽然分诊联络员角色在有额外资源时可能是改善 ED 吞吐量的一种方式，正如我们之前的研究所示，但分诊联络员模式本身似乎并没有取代治疗室的人员配备，正如本研究所示。
