Mandel Asher L, Bove Thomas, Parekh Amisha D, Datillo Paris, Bove Joseph, Bove Linda, Bove Joseph J, Birkhahn Robert H
Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Open Access Emerg Med. 2020 Feb 11;12:13-18. doi: 10.2147/OAEM.S228291. eCollection 2020.
Emergency Department (ED) crowding negatively impacts patient outcomes, patient satisfaction, and patient safety. One solution involves introducing a Concierge Physician (CP) whose sole purpose is to provide a brief initial assessment (BIA) and aid patient navigation through the ED. The goal of this study was to quantify the impact of a CP on patient flow dynamics in an urban ED setting.
We performed a retrospective observational cohort study in an urban academic ED over a 6-month period. Initially, the CP was present in the treatment area during weekdays; during the last half of the observation period, an additional CP was added to the waiting room on weekends. We identified four major milestones in the ED visit with regards to patient throughput. Adult patients presenting to the ED with a triage level of Urgent (ESI 3) were analyzed for this study. Data were stratified based on the patient's ultimate disposition (admitted or discharged) and presented as means with predictive analysis.
Between August 2016 and January 2017, the ED evaluated 42,397 adult patients. Of those, 26,976 (64%) were triage level Urgent (3). Of the level 3 patients, 10,279 (38%) received a BIA from a CP. Patients evaluated by a CP were seen approximately 30 mins faster (40% reduction in Door to Doctor time), but stayed 30 mins longer in the ED on average, because the medical decision-making process took >1 hr longer when the patient was initially evaluated by a CP.
Adapting a concierge medicine model to rapidly evaluate patients resulted in a dramatically reduced Door to Doctor time, but an increase in overall time spent in the ED. This discrepancy was a direct result of the delay in physician disposition.
急诊科拥挤对患者预后、患者满意度和患者安全产生负面影响。一种解决方案是引入礼宾医师（CP），其唯一目的是进行简短的初始评估（BIA）并协助患者在急诊科就诊。本研究的目的是量化礼宾医师对城市急诊科患者流动动态的影响。
我们在一家城市学术急诊科进行了为期6个月的回顾性观察队列研究。最初，礼宾医师在工作日出现在治疗区域；在观察期的后半段，周末在候诊室增加了一名礼宾医师。我们确定了急诊科就诊过程中与患者吞吐量相关的四个主要里程碑。本研究分析了分诊级别为紧急（ESI 3）的成年急诊患者。数据根据患者的最终处置情况（入院或出院）进行分层，并以预测分析的均值形式呈现。
2016年8月至2017年1月期间，急诊科评估了42397名成年患者。其中，26976名（64%）分诊级别为紧急（3级）。在3级患者中，10279名（38%）接受了礼宾医师的BIA。由礼宾医师评估的患者就诊时间快约30分钟（从挂号到见到医生的时间减少40%），但在急诊科平均停留时间长30分钟，因为当患者最初由礼宾医师评估时，医疗决策过程耗时超过1小时。
采用礼宾医疗模式快速评估患者可显著缩短从挂号到见到医生的时间，但会增加在急诊科的总停留时间。这种差异是医师处置延迟的直接结果。
