Impact of Provider-In-Triage in a Safety-Net Hospital.

Abstract

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 3days a week from January through April 2019. As controls, we compared throughput metrics from when PIT was unavailable (Group 2) and from 1year 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 (148min, interquartile range [IQR] 88, 226min) compared with 2 (187min, IQR 95.5, 266min) and 3 (215min, IQR 131, 290min). EDLOS was significantly (p<0.001) shorter for Group 1 (337min, IQR 215, 468min) compared with 2 (385min, IQR 271, 516min) and 3 (413min, IQR 299, 538min). 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.