Implementing Triage Standing Orders in the Emergency Department Leads to Reduced Physician-to-Disposition Times

Charles W Hwang,Michelle Plourde,Thomas Payton,Emily Weeks

doi:10.1155/2016/7213625

Charles W Hwang, Michelle Plourde + Show 2 more

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https://doi.org/10.1155/2016/7213625

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Abstract

Emergency departments (EDs) throughout USA have improvised various processes to curb the “national epidemic” termed ED “crowding.” Standing orders (SOs), one such process, are medical orders approved by the medical director and entered by nurses when patients cannot be seen expeditiously, expediting medical decision-making and decreasing length of stay (LOS) and time to disposition. This retrospective cohort study evaluates the impact of SOs on ED LOS and disposition time at a large university ED. Results indicate that SOs significantly improve ED throughput by reducing disposition time by up to 16.9% (p=0.04), which is especially significant in busy ED settings. SOs by themselves are not sufficient for a complete diagnostic assessment. Strategies such as having a provider in the waiting area may help make key decisions earlier.

Highlights

Throughout the United States, emergency departments (EDs) are called upon to care for more and more patients; from 1995 to 2005, annual ED visits increased by 20% and ED utilization increased by 7%, from 36.9 to 39.6 ED visits per 100 persons [1,2,3,4,5]
For patients with chest pain, there was a reduction in the median “provider evaluation to disposition” time, from 154 min in the no-standing orders group to 128 min (26 min decrease, 16.9%, p = 0.04) if all diagnostic studies were completed before the patient was evaluated by a provider
ED length of stay (LOS) was higher among the standing orders group, at 614 min, compared to 402 min in the no-standing orders group

Summary

Introduction

Despite the increase in patient volume and complexity, hospital and ED resources have not increased proportionately Instead, during this same period, the number of EDs decreased by 381, the number of hospitals decreased by 535, and the number of inpatient hospital beds decreased by 134,000 [1,2,3,4]. These trends have resulted in ED “crowding” described by the American College of Emergency Physicians (ACEP) as “when the identified need for emergency services exceeds available resources for patient care in the ED, hospital, or both.” [6]. As the ED system is overburdened by crowding, the quality and safety of emergency care decline

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