The Impact of Involving a Senior Emergency Physician in the Triage Process

Abstract

BACKGROUND: Emergency Department (ED) overcrowding has been demonstrated in several studies to be associated with undesirable effects such as longer waiting times, reduced patient satisfaction, and, most importantly, poor patient outcomes. Furthermore, long waiting times for walk-ins result in more complaints and patient dissatisfaction than illness management itself, with the majority of issues arising as a result of real and perceived waiting periods before being seen by the doctor. AIM: We set out to investigate whether introducing a senior emergency physician into the triage system would reduce waiting time, door-to-decision time, and door-to-doctor time, as well as increase patient satisfaction across the ED. METHOD: This was an interventional pre-post study that utilised retrospective data to evaluate the effect on ED throughput of triage by senior emergency physicians. We aimed to measure its impact on waiting time, door-to-decision time, and door-to-doctor time, along with ED patient satisfaction. RESULTS: Patient satisfaction, the overall assessment of treatment received during the visit, increased, from 74.975 to 77.425, and the likelihood of patients recommending the ED increased from 71.36 to 75.21. Operational metrics revealed a considerable drop in door-to-decision time (admit or discharge) of 46 minutes and 3 seconds, as well as a 1 minute and 21 second reduction in time from door to doctor (arrival to first provider). CONCLUSION: The mixed results hint at an effective but iterative process of enhancing patient flow and experience in the ED through senior physician triage.