Abstract
BackgroundDiagnostic testing in the ED increases the length of stay (LOS). Urinalysis testing is highlighted specifically as a source of delays. We aim to determine whether a triage-initiated urine specimen collection process decreases ED time to disposition (TTD) in ambulatory patients with abdominal pain.MethodsThis prospective, randomized controlled study was implemented at a Suburban Level One trauma ED with greater than 120,000 annual visits. A convenience sample of patients was recruited. Adult, non-ambulance patients presenting with abdominal pain were eligible. Participants were randomized into experimental and control groups. Patients in the control group provided a urine sample after physician evaluation, if ordered by the provider. Patients in the experimental group were prompted to provide a urine sample in the triage restrooms immediately after screening at the greeter desk. The UA sample was transported to the treatment area and sent to the laboratory after physician evaluation.ResultsA total of 125 control patients and 124 experimental patients were enrolled. Forty-two patients were excluded because they were unable to provide a urine sample. Patients who had a urinalysis ordered were included in statistical analysis. Final data set included 65 patients in the experimental group and 96 patients in the control group. No significant difference (p=0.5072) in disposition time between subjects in the experimental group (n=65, mean=5:17 [hours:min]) and subjects in the control group (n=96, mean=5:30) was found.ConclusionsThe triage protocol for urine specimen collection did not significantly reduce ED TTD. Further research in overcrowded EDs with long patient waiting room times may benefit from implementing a triage protocol for urine specimen collection.
Highlights
In the past 20 years, the number of visits to EDs has increased substantially
Patients who had a urinalysis ordered were included in statistical analysis
Further research in overcrowded EDs with long patient waiting room times may benefit from implementing a triage protocol for urine specimen collection
Summary
In the past 20 years, the number of visits to EDs has increased substantially. This increased number of visits has contributed to ED overcrowding nationwide [1,2,3,4,5]. Previous studies have identified the need for more front-end operations that can be used to decrease ED LOS and time to disposition (TTD) [13,14]. An example of such mechanism is a study by Singer et al, in which point-of-care troponin testing for patients with chest pain reduced TTD compared to patients whose troponin was measured in a central laboratory [15]. The previous studies are examples of utilization of specific front-end operations based on chief complaint and presentation By implementing these operations, ED TTD decreases, ED LOS decreases, treatment delays are reduced, and patient outcomes are improved [18,19,20,21,22,23,24]. We aim to determine whether a triage-initiated urine specimen collection process decreases ED time to disposition (TTD) in ambulatory patients with abdominal pain
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