Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact
Abstract Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub‐optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs—which typically involve, at a minimum, a physician or advance...
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| Format: | Article |
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Elsevier
2021-06-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12450 |
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| author | Brian J. Franklin Kathleen Y. Li David M. Somand Keith E. Kocher Steven L. Kronick Vikas I. Parekh Eric Goralnick A. Tyler Nix Nathan L. Haas |
| author_facet | Brian J. Franklin Kathleen Y. Li David M. Somand Keith E. Kocher Steven L. Kronick Vikas I. Parekh Eric Goralnick A. Tyler Nix Nathan L. Haas |
| author_sort | Brian J. Franklin |
| collection | DOAJ |
| description | Abstract Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub‐optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs—which typically involve, at a minimum, a physician or advanced practice provider conducting an initial screening exam and potentially initiating treatment and diagnostic testing at the time of triage—are frequently endorsed as a mechanism to reduce ED length of stay (LOS) and therefore mitigate crowding, improve patient satisfaction, and improve ED operational and financial performance. However, the peer‐reviewed evidence regarding the impact of PIT programs on measures including ED LOS, wait times, and costs (as variously defined) is mixed. Mechanistically, PIT programs exert their effects by initiating diagnostic work‐ups earlier and, sometimes, by equipping triage providers to directly disposition patients. However, depending on local contextual factors—including the co‐existence of other front‐end interventions and delays in ED throughput not addressed by PIT—we demonstrate how these features may or may not ultimately translate into reduced ED LOS in different settings. Consequently, site‐specific analysis of the root causes of excessive ED LOS, along with mechanistic assessment of potential countermeasures, is essential for appropriate deployment and successful design of PIT programs at individual EDs. Additional motivations for implementing PIT programs may include their potential to enhance patient safety, patient satisfaction, and team dynamics. In this conceptual article, we address a gap in the literature by demonstrating the mechanisms underlying PIT program results and providing a framework for ED decision‐makers to assess the local rationale for, operational feasibility of, and financial impact of PIT programs. |
| format | Article |
| id | doaj-art-ada42b4254a340a892baec02c30b04af |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-ada42b4254a340a892baec02c30b04af2025-08-20T02:15:41ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522021-06-0123n/an/a10.1002/emp2.12450Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impactBrian J. Franklin0Kathleen Y. Li1David M. Somand2Keith E. Kocher3Steven L. Kronick4Vikas I. Parekh5Eric Goralnick6A. Tyler Nix7Nathan L. Haas8University of Michigan Medical School Ann Arbor Michigan USAInstitute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USADepartment of Emergency Medicine Michigan Medicine Ann Arbor Michigan USAInstitute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USADepartment of Emergency Medicine Michigan Medicine Ann Arbor Michigan USADepartment of Internal Medicine Michigan Medicine Ann Arbor Michigan USADepartment of Emergency Medicine Brigham and Women's Hospital Boston Massachusetts USATaubman Health Sciences Library University of Michigan Ann Arbor Michigan USADepartment of Emergency Medicine Michigan Medicine Ann Arbor Michigan USAAbstract Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub‐optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs—which typically involve, at a minimum, a physician or advanced practice provider conducting an initial screening exam and potentially initiating treatment and diagnostic testing at the time of triage—are frequently endorsed as a mechanism to reduce ED length of stay (LOS) and therefore mitigate crowding, improve patient satisfaction, and improve ED operational and financial performance. However, the peer‐reviewed evidence regarding the impact of PIT programs on measures including ED LOS, wait times, and costs (as variously defined) is mixed. Mechanistically, PIT programs exert their effects by initiating diagnostic work‐ups earlier and, sometimes, by equipping triage providers to directly disposition patients. However, depending on local contextual factors—including the co‐existence of other front‐end interventions and delays in ED throughput not addressed by PIT—we demonstrate how these features may or may not ultimately translate into reduced ED LOS in different settings. Consequently, site‐specific analysis of the root causes of excessive ED LOS, along with mechanistic assessment of potential countermeasures, is essential for appropriate deployment and successful design of PIT programs at individual EDs. Additional motivations for implementing PIT programs may include their potential to enhance patient safety, patient satisfaction, and team dynamics. In this conceptual article, we address a gap in the literature by demonstrating the mechanisms underlying PIT program results and providing a framework for ED decision‐makers to assess the local rationale for, operational feasibility of, and financial impact of PIT programs.https://doi.org/10.1002/emp2.12450emergency department boardingemergency department crowdingemergency department physician in triageemergency department provider in triagehospital capacitypatient flow |
| spellingShingle | Brian J. Franklin Kathleen Y. Li David M. Somand Keith E. Kocher Steven L. Kronick Vikas I. Parekh Eric Goralnick A. Tyler Nix Nathan L. Haas Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact Journal of the American College of Emergency Physicians Open emergency department boarding emergency department crowding emergency department physician in triage emergency department provider in triage hospital capacity patient flow |
| title | Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact |
| title_full | Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact |
| title_fullStr | Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact |
| title_full_unstemmed | Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact |
| title_short | Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact |
| title_sort | emergency department provider in triage assessing site specific rationale operational feasibility and financial impact |
| topic | emergency department boarding emergency department crowding emergency department physician in triage emergency department provider in triage hospital capacity patient flow |
| url | https://doi.org/10.1002/emp2.12450 |
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