A physician-nurse team adjacent to triage shortens length of stay and left-without-being-seen rates.

OBJECTIVE

Staffing significantly influences emergency department (ED) throughput; however, there is a shortage of registered nurses (RNs), impacting ED flow and crowding. Non-RN providers, like licensed practical nurses (LPNs), could potentially assist with tasks traditionally assigned to RNs. To improve the front-end ED process, we implemented an attending physician-LPN team (PNT) positioned next to triage and utilized existing ED hallway space.

METHODS

This study took place at a tertiary care ED with over 110,000 annual visits. We compared postintervention (post-PNT) data (November 1, 2022-February 28, 2023) to preintervention (pre-PNT) data (July 31, 2022-October 31, 2022). The PNT, positioned adjacent to triage, expedited care for ED patients awaiting open rooms. The PNT selected patients from the waiting room to bypass the main ED, evaluated them in a private room, and then moved them to the hallway pending further care. Multivariable regression analysis was utilized to measure the impact of different factors on ED length of stay (LOS).

RESULTS

We analyzed 23,516 patient visits, 10,288 in the pre-PNT period and 13,288 in the postPNT period. Post-PNT consisted of 2,454 PNT visits and 10,834 non-PNT visits. The intervention led to significant improvements, including a decrease in mean ED LOS from 492 to 425 minutes, a decrease in 72-hour revisits from 5.1% to 4.0%, a decrease in left-without-being-seen rate from 6.7% to 3.3%, and a decrease in the mean arrival-to-provider time from 74 to 60 minutes. Multivariable regression analysis showed that ED LOS was significantly lower for post-PNT patients than pre-PNT.

CONCLUSION

By leveraging the scope of LPNs and utilizing existing ED space, the PNT model successfully reduced front-end bottlenecks, leading to improved throughput and reduced revisitation and left-without-being-seen rates.