Department of Emergency Medicine, Kings County Hospital, Brooklyn, New York; Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York.
J Emerg Med. 2020 Sep;59(3):459-465. doi: 10.1016/j.jemermed.2020.04.059. Epub 2020 Jun 25.
Increasing emergency department (ED) utilization has contributed to ED overcrowding, with longer ED length of stay (EDLOS) and more patients leaving without being seen (LWBS), and is associated with higher morbidity and mortality rates. Previous studies of provider in triage (PIT) have shown decreased LWBS, but variable improvements in EDLOS.
We evaluated the impact of PIT implementation in an urban safety-net hospital on commonly reported ED throughput metrics.
This before-and-after study was performed at an academic urban safety hospital. We implemented a PIT team that screened ambulatory ED patients for early discharge or expedited workup. The PIT intervention was implemented 3 days a week from January through April 2019. As controls, we compared throughput metrics from when PIT was unavailable (Group 2) and from 1 year prior (Group 3).
There were significantly (p < 0.001) lower rates of LWBS in Group 1 (4.8%, 95% confidence interval [CI] 4.1-5.8%) compared with 2 (7.3%, 95% CI 5.5-9.7%) and 3 (7.8%, 95% CI 6.9-9.0%). Door-to-doctor times were significantly (p < 0.001) lower for Group 1 (148 min, interquartile range [IQR] 88, 226 min) compared with 2 (187 min, IQR 95.5, 266 min) and 3 (215 min, IQR 131, 290 min). EDLOS was significantly (p < 0.001) shorter for Group 1 (337 min, IQR 215, 468 min) compared with 2 (385 min, IQR 271, 516 min) and 3 (413 min, IQR 299, 538 min).
We found significantly lower LWBS rates, shorter EDLOS, and shorter door-to-doctor times after PIT implementation. Compared with previous studies in a variety of settings, we found that PIT significantly improved LWBS and all throughput metrics in a safety net setting.
急诊科（ED）就诊量的增加导致了 ED 过度拥挤，表现为 ED 停留时间（EDLOS）延长和更多患者未得到诊治（LWBS），并与更高的发病率和死亡率相关。先前关于分诊提供者（PIT）的研究表明 LWBS 减少，但 EDLOS 改善情况不同。
我们评估了在城市医疗保障医院实施 PIT 对常见 ED 吞吐量指标的影响。
这是一项在学术性城市医疗保障医院进行的前后对照研究。我们建立了一个 PIT 团队，对门诊 ED 患者进行早期出院或加快检查的筛查。该 PIT 干预措施在 2019 年 1 月至 4 月期间每周实施 3 天。作为对照组，我们比较了在 PIT 不可用时（第 2 组）和 1 年前（第 3 组）的吞吐量指标。
第 1 组（4.8%，95%置信区间[CI] 4.1-5.8%）的 LWBS 率显著低于第 2 组（7.3%，95%CI 5.5-9.7%）和第 3 组（7.8%，95%CI 6.9-9.0%）（p<0.001）。第 1 组的门到医生时间显著低于第 2 组（148 分钟，四分位距[IQR] 88,226 分钟）和第 3 组（187 分钟，IQR 95.5,266 分钟）（p<0.001）。第 1 组的 EDLOS 显著短于第 2 组（337 分钟，IQR 215,468 分钟）和第 3 组（385 分钟，IQR 271,516 分钟）（p<0.001）。
我们发现实施 PIT 后 LWBS 率显著降低、EDLOS 缩短和门到医生时间缩短。与各种环境中的先前研究相比，我们发现 PIT 在医疗保障环境中显著改善了 LWBS 和所有吞吐量指标。
