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Does a Provider in Triage and Rapid Medical Evaluation Help With Left Without Being Seen Rates and ED Crowding?
J Emerg Nurs. 2019 Jan; 45(1):38-45.JE

Abstract

INTRODUCTION

Attempting to reduce ED crowding, the ED team at a rural academic medical center and specialty hospital implemented rapid medical evaluation (RME) with and without a provider in triage (PIT). The purpose of this performance improvement project was to explore how these interventions affected crowding metrics of door-to-disposition time, ED length of stay (LOS), and left without being seen (LWBS) rates for all patients.

METHODS

Using a prospective 2-group design, the pre-RME population served as the historical control group, and postintervention groups included both RME with and without PIT. Group comparisons of crowding metrics included pre- and post-RME with and without PIT.

RESULTS

There were no statistically significant differences in any of the crowding metrics for the emergency severity index (ESI) 3 groups pre- or post-RME. However, mean door-to-disposition times for the post-RME ESI 5 population were shorter compared with the pre-RME ESI 5 patients (2:59:23 vs. 2:00: 42; P = 0.037). Analysis of the post-RME population with and without PIT did not demonstrate significant differences across ESI 3 or 5 groups. Comparisons of post-RME data revealed a significant increase in ED LOS for all admitted patients regardless of their ESI (P = 0.023) and also door-to-disposition times for ESI level-4 patient groups, both with and without PIT (P = 0.022).

IMPLICATIONS FOR PRACTICE

The findings support other studies demonstrating that RME can have positive impact on ED crowding metrics for some patients. Although PIT took longer for some patients, anecdotal findings revealed benefits related to direct discharges and admission occurring during the RME process.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30293816

Citation

Jesionowski, Monique, et al. "Does a Provider in Triage and Rapid Medical Evaluation Help With Left Without Being Seen Rates and ED Crowding?" Journal of Emergency Nursing, vol. 45, no. 1, 2019, pp. 38-45.
Jesionowski M, Riordan J, Quatrara B. Does a Provider in Triage and Rapid Medical Evaluation Help With Left Without Being Seen Rates and ED Crowding? J Emerg Nurs. 2019;45(1):38-45.
Jesionowski, M., Riordan, J., & Quatrara, B. (2019). Does a Provider in Triage and Rapid Medical Evaluation Help With Left Without Being Seen Rates and ED Crowding? Journal of Emergency Nursing, 45(1), 38-45. https://doi.org/10.1016/j.jen.2018.09.001
Jesionowski M, Riordan J, Quatrara B. Does a Provider in Triage and Rapid Medical Evaluation Help With Left Without Being Seen Rates and ED Crowding. J Emerg Nurs. 2019;45(1):38-45. PubMed PMID: 30293816.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does a Provider in Triage and Rapid Medical Evaluation Help With Left Without Being Seen Rates and ED Crowding? AU - Jesionowski,Monique, AU - Riordan,John, AU - Quatrara,Beth, Y1 - 2018/10/04/ PY - 2017/05/04/received PY - 2018/09/03/revised PY - 2018/09/04/accepted PY - 2018/10/9/pubmed PY - 2019/5/2/medline PY - 2018/10/9/entrez KW - ED crowding KW - Left without being seen KW - Physician in triage KW - Provider in triage KW - Rapid medical evaluation KW - Triage SP - 38 EP - 45 JF - Journal of emergency nursing JO - J Emerg Nurs VL - 45 IS - 1 N2 - INTRODUCTION: Attempting to reduce ED crowding, the ED team at a rural academic medical center and specialty hospital implemented rapid medical evaluation (RME) with and without a provider in triage (PIT). The purpose of this performance improvement project was to explore how these interventions affected crowding metrics of door-to-disposition time, ED length of stay (LOS), and left without being seen (LWBS) rates for all patients. METHODS: Using a prospective 2-group design, the pre-RME population served as the historical control group, and postintervention groups included both RME with and without PIT. Group comparisons of crowding metrics included pre- and post-RME with and without PIT. RESULTS: There were no statistically significant differences in any of the crowding metrics for the emergency severity index (ESI) 3 groups pre- or post-RME. However, mean door-to-disposition times for the post-RME ESI 5 population were shorter compared with the pre-RME ESI 5 patients (2:59:23 vs. 2:00: 42; P = 0.037). Analysis of the post-RME population with and without PIT did not demonstrate significant differences across ESI 3 or 5 groups. Comparisons of post-RME data revealed a significant increase in ED LOS for all admitted patients regardless of their ESI (P = 0.023) and also door-to-disposition times for ESI level-4 patient groups, both with and without PIT (P = 0.022). IMPLICATIONS FOR PRACTICE: The findings support other studies demonstrating that RME can have positive impact on ED crowding metrics for some patients. Although PIT took longer for some patients, anecdotal findings revealed benefits related to direct discharges and admission occurring during the RME process. SN - 1527-2966 UR - https://www.unboundmedicine.com/medline/citation/30293816/Does_a_Provider_in_Triage_and_Rapid_Medical_Evaluation_Help_With_Left_Without_Being_Seen_Rates_and_ED_Crowding L2 - https://linkinghub.elsevier.com/retrieve/pii/S0099-1767(17)30253-2 DB - PRIME DP - Unbound Medicine ER -