Premium
Effect of a Physician Assistant as Triage Liaison Provider on Patient Throughput in an Academic Emergency Department
Author(s) -
Nestler David M.,
Fratzke Alesia R.,
Church Christopher J.,
ScanlanHanson Lori,
Sadosty Annie T.,
Halasy Michael P.,
Finley Janet L.,
Boggust Andy,
Hess Erik P.
Publication year - 2012
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12010
Subject(s) - medicine , interquartile range , emergency department , triage , emergency medicine , observational study , surgery , psychiatry
Objectives Overcapacity issues plague emergency departments ( ED s). Studies suggest that triage liaison providers ( TLP s) may shorten patient length of stay ( LOS ) and reduce the proportion of patients who leave without being seen ( LWBS ), but these results are not universal. Previous studies used physicians as TLP s. We evaluated whether a physician assistant ( PA ), acting as a TLP , would shorten LOS and decrease LWBS rates. Methods The authors used an observational cohort controlled before‐and‐after study design with predefined outcome measures, comparing 8 pilot days to 8 control days. The TLP evaluated all Emergency Severity Index ( ESI ) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients. Results A total of 353 patients were included on pilot days and 371 on control days. LOS was shorter on pilot days than control days (median [interquartile range { IQR }] = 229 [168 to 303] minutes vs. 270 [187 to 372] minutes, p < 0.001). Waiting room times were similar between pilot and control days (median [ IQR ] = 69 [20 to 119] minutes vs. 70 [19 to 137] minutes, p = 0.408), but treatment room times were shorter (median [ IQR ] = 151 [92 to 223] minutes vs. 187 [110 to 254] minutes, p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4% vs. 9.7%, p < 0.001). Conclusions The addition of a PA as a TLP was associated with a 41‐minute decrease in median total LOS and a lower proportion of patients who LWBS . The decrease in total LOS is likely attributable to the addition of the TLP , with patients having shorter duration in treatment rooms on pilot days compared to control days.