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Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on d...

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Autores principales: Lauks, Juliane, Mramor, Blaz, Baumgartl, Klaus, Maier, Heinrich, Nickel, Christian H., Bingisser, Roland
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841508/
https://www.ncbi.nlm.nih.gov/pubmed/27104911
http://dx.doi.org/10.1371/journal.pone.0154372
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author Lauks, Juliane
Mramor, Blaz
Baumgartl, Klaus
Maier, Heinrich
Nickel, Christian H.
Bingisser, Roland
author_facet Lauks, Juliane
Mramor, Blaz
Baumgartl, Klaus
Maier, Heinrich
Nickel, Christian H.
Bingisser, Roland
author_sort Lauks, Juliane
collection PubMed
description Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17(th) 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8–66.6) to 10.2 (5.7–18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2–84.7) to 10.5 (5.9–18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1–5.3) to 3.7 (2.3–5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8–1.8) to 0.3 (0.2–0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology, anticipating that it may be better for the downstream physician to have more information rather than less.
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spelling pubmed-48415082016-04-29 Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay Lauks, Juliane Mramor, Blaz Baumgartl, Klaus Maier, Heinrich Nickel, Christian H. Bingisser, Roland PLoS One Research Article Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17(th) 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8–66.6) to 10.2 (5.7–18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2–84.7) to 10.5 (5.9–18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1–5.3) to 3.7 (2.3–5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8–1.8) to 0.3 (0.2–0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology, anticipating that it may be better for the downstream physician to have more information rather than less. Public Library of Science 2016-04-22 /pmc/articles/PMC4841508/ /pubmed/27104911 http://dx.doi.org/10.1371/journal.pone.0154372 Text en © 2016 Lauks et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Lauks, Juliane
Mramor, Blaz
Baumgartl, Klaus
Maier, Heinrich
Nickel, Christian H.
Bingisser, Roland
Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay
title Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay
title_full Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay
title_fullStr Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay
title_full_unstemmed Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay
title_short Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay
title_sort medical team evaluation: effect on emergency department waiting time and length of stay
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841508/
https://www.ncbi.nlm.nih.gov/pubmed/27104911
http://dx.doi.org/10.1371/journal.pone.0154372
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