Physician Triage Reduces Emergency Wait Times

Across the country wait times to see providers in Emergency Departments are of colossal concern. Lengthy wait times for walk in Emergency Department patients may result in: delayed diagnosis, prolonged testing, patients leaving without being seen, and poor patient satisfaction. Many facilities have implemented a physician in triage rather than the contrasting system in place; a nurse in triage. Curiosity led the comparison of these two triage approaches.

Physician Triage Reduces Emergency Wait Times University of Utah College of Nursing Kaitlyn Glaspie, University of Utah BSN Student INTRODUCTION OF PROBLEM METHODS FOR IMPROVEMENT DISCUSSION Across the country wait times to see In attempt to improve this problem, research was providers in Emergency Departments are of synthesized from existing studies. These findings show significantly decreased wait times in ED walk in patients and therefore quicker treatment provided for patients in need of urgent or emergent care. colossal concern. Lengthy wait times for walk in Emergency Studies were selected by fulfilling the requirement of sharing Department patients may result in: a common implementation. Limitations & Barriers • Delayed diagnosis • Prolonged testing All studies synthesized had implemented a physician in • Staffing • Patients leaving without being seen triage. • Lack of open rooms for triage purpose • Poor patient satisfaction. RESULTS Investigation Many facilities have implemented a physician in triage rather than the contrasting system in place; a nurse in triage. Curiosity led the comparison of • Physician's desire to triage • Funding 1. Health Care Provider in Triage to Improve Outcomes Strategies to Gain Cooperation Results were astounding with wait times decreasing "from a high of 56 minutes to a low of 13 minutes." • Dissemination of current research (Spencer, 2019, p. 561) these two triage approaches. • Simulations of PIT • Statements from staff currently working PIT in their ED's Metric to Measure PICOT Question In Emergency Department walk-in patients, 2. Impact of Physician Screening in the Emergency Department on Patient Flow nursing triage, affect wait times in the ED "the median time to disposition decision decreased by six minutes, and the time to physician evaluation, analgesia, antiemetic, antibiotic, and radiology order decreased…" within three months of implementation? (Soremekun, 2012 p. 509) how does physician-in triage compared to • Door to physician wait times • Patient satisfaction through feedback cards CONCLUSION Next steps include: 3. Effectiveness of the Manchester Triage System on time to treatment in the emergency department • A new protocol to implement PIT in emergency departments across the country. "The intervention's median physician initial assessment time was 0:55 versus 1:21." • Gather resources and use set strategies to gain cooperation (Cheng, 2013) • Use metrics to measure implementations success in a 3 month time. References: Cheng, I., Lee, J., Mittmann, N., Tyberg, J., Ramagnano, S., Kiss, A., Schull, M., Kerr, F., Zwarenstein, M. (2013) Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times. BMC Emergency Medicine. 13(17) https://doi.org/10.1186/1471-227X-13-17 Soremekun, O., Capp, R., Biddinger, P., White, B., Chang, Y., Carignan, S., Brown, D. (2012). Impact of physician screening in the emergency department on patient flow. The Journal of Emergency Medicine, 43(3), 509-515.https://doi.org/10.1016/j.jemermed.2012.01.025 Spencer, S., Stephens, K., Swanson-Biearman, B., Whiteman, K.(2019). Health care provider in triage to improve outcomes. Journal of Emergency Nursing,45(5) 561-566. https://doi.org/10.1016/j.jen.2019.01.008