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Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department.
J Emerg Med. 2012 Mar; 42(3):322-8.JE

Abstract

BACKGROUND

Emergency Department (ED) crowding is well recognized, and multiple studies have demonstrated its negative effect on patient care.

STUDY OBJECTIVES

This study aimed to assess the effect of an intervention, Supplemented Triage and Rapid Treatment (START), on standard ED performance measures. The START program complemented standard ED triage with a team of clinicians who initiated the diagnostic work-up and selectively accelerated disposition in a subset of patients.

METHODS

This retrospective before-after study compared performance measures over two 3-month periods (September-November 2007 and 2008) in an urban, academic tertiary care ED. Data from an electronic patient tracking system were queried over 12,936 patients pre-intervention, and 14,220 patients post-intervention. Primary outcomes included: 1) overall length of stay (LOS), 2) LOS for discharged and admitted patients, and 3) the percentage of patients who left without complete assessment (LWCA).

RESULTS

In the post-intervention period, patient volume increased 9% and boarder hours decreased by 1.3%. Median overall ED LOS decreased by 29 min (8%, 361 min pre-intervention, 332 min post-intervention; p < 0.001). Median LOS for discharged patients decreased by 23 min (7%, 318 min pre-intervention, 295 min post-intervention; p < 0.001), and by 31 min (7%, 431 min pre-intervention, 400 min post-intervention) for admitted patients. LWCA was decreased by 1.7% (4.1% pre-intervention, 2.4% post-intervention; p < 0.001).

CONCLUSIONS

In this study, a comprehensive screening and clinical care program was associated with a significant decrease in overall ED LOS, LOS for discharged and admitted patients, and rate of LWCA, despite an increase in ED patient volume.

Authors+Show Affiliations

Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20554420

Citation

White, Benjamin A., et al. "Supplemented Triage and Rapid Treatment (START) Improves Performance Measures in the Emergency Department." The Journal of Emergency Medicine, vol. 42, no. 3, 2012, pp. 322-8.
White BA, Brown DF, Sinclair J, et al. Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department. J Emerg Med. 2012;42(3):322-8.
White, B. A., Brown, D. F., Sinclair, J., Chang, Y., Carignan, S., McIntyre, J., & Biddinger, P. D. (2012). Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department. The Journal of Emergency Medicine, 42(3), 322-8. https://doi.org/10.1016/j.jemermed.2010.04.022
White BA, et al. Supplemented Triage and Rapid Treatment (START) Improves Performance Measures in the Emergency Department. J Emerg Med. 2012;42(3):322-8. PubMed PMID: 20554420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department. AU - White,Benjamin A, AU - Brown,David F M, AU - Sinclair,Julia, AU - Chang,Yuchiao, AU - Carignan,Sarah, AU - McIntyre,Joyce, AU - Biddinger,Paul D, Y1 - 2010/06/15/ PY - 2009/11/05/received PY - 2010/01/27/revised PY - 2010/04/13/accepted PY - 2010/6/18/entrez PY - 2010/6/18/pubmed PY - 2012/6/8/medline SP - 322 EP - 8 JF - The Journal of emergency medicine JO - J Emerg Med VL - 42 IS - 3 N2 - BACKGROUND: Emergency Department (ED) crowding is well recognized, and multiple studies have demonstrated its negative effect on patient care. STUDY OBJECTIVES: This study aimed to assess the effect of an intervention, Supplemented Triage and Rapid Treatment (START), on standard ED performance measures. The START program complemented standard ED triage with a team of clinicians who initiated the diagnostic work-up and selectively accelerated disposition in a subset of patients. METHODS: This retrospective before-after study compared performance measures over two 3-month periods (September-November 2007 and 2008) in an urban, academic tertiary care ED. Data from an electronic patient tracking system were queried over 12,936 patients pre-intervention, and 14,220 patients post-intervention. Primary outcomes included: 1) overall length of stay (LOS), 2) LOS for discharged and admitted patients, and 3) the percentage of patients who left without complete assessment (LWCA). RESULTS: In the post-intervention period, patient volume increased 9% and boarder hours decreased by 1.3%. Median overall ED LOS decreased by 29 min (8%, 361 min pre-intervention, 332 min post-intervention; p < 0.001). Median LOS for discharged patients decreased by 23 min (7%, 318 min pre-intervention, 295 min post-intervention; p < 0.001), and by 31 min (7%, 431 min pre-intervention, 400 min post-intervention) for admitted patients. LWCA was decreased by 1.7% (4.1% pre-intervention, 2.4% post-intervention; p < 0.001). CONCLUSIONS: In this study, a comprehensive screening and clinical care program was associated with a significant decrease in overall ED LOS, LOS for discharged and admitted patients, and rate of LWCA, despite an increase in ED patient volume. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/20554420/Supplemented_Triage_and_Rapid_Treatment__START__improves_performance_measures_in_the_emergency_department_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(10)00290-8 DB - PRIME DP - Unbound Medicine ER -