Annals of Emergency Medicine
Volume 56, Issue 1 , Pages 27-33 , July 2010

Placing Physician Orders at Triage: The Effect on Length of Stay

  • Stephan Russ, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
    • Department of Veterans Affairs, National Quality Scholars Fellowship Program, Tennessee Valley Healthcare System, Nashville, TN
    • Corresponding Author InformationAddress for correspondence: Stephan Russ, MD, MPH, Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232-4700; 615-936-1160, fax 615-936-1316
  • ,
  • Ian Jones, MD

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
  • ,
  • Dominik Aronsky, MD, PhD

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
    • Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
  • ,
  • Robert S. Dittus, MD, MPH

      Affiliations

    • Department of Medicine, Division of General Internal Medicine and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
    • Department of Veterans Affairs, National Quality Scholars Fellowship Program, Tennessee Valley Healthcare System, Nashville, TN
  • ,
  • Corey M. Slovis, MD

      Affiliations

    • Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN

Received 30 October 2009 ,Revised 28 January 2010 ,Accepted 3 February 2010.

References 

  1. Moskop JC, Sklar DP, Geiderman JM, et al. Emergency department crowding, part 1: concept, causes, and moral consequences. Ann Emerg Med. 2009;53:605–611
  2. Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20:402–405
  3. Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52:126–136
  4. Derlet RW. Overcrowding in emergency departments: increased demand and decreased capacity. Ann Emerg Med. 2002;39:430–432
  5. Moskop JC, Sklar DP, Geiderman JM, et al. Emergency department crowding, part 2: barriers to reform and strategies to overcome them. Ann Emerg Med. 2009;53:612–617
  6. Carr BG, Hollander JE, Baxt WG, et al. Trends in boarding of admitted patients in US emergency departments 2003-2005. J Emerg Med. In press.
  7. Olshaker JS, Rathlev NK. Emergency department overcrowding and ambulance diversion: the impact and potential solutions of extended boarding of admitted patients in the Emergency Department. J Emerg Med. 2006;30:351–356
  8. Bernstein SL, Aronsky D, Duseja R, et al. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16:1–10
  9. McCarthy ML, Zeger SL, Ding R, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med. In press.
  10. Diercks DB, Roe MT, Chen AY, et al. Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Ann Emerg Med. 2007;50:489–496
  11. Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:1–5
  12. Pines JM, Hollander JE, Localio AR, et al. The association between emergency department crowding and hospital performance on antibiotic timing for pneumonia and percutaneous intervention for myocardial infarction. Acad Emerg Med. 2006;13:873–878
  13. Wiler JL, Gentle C, Halfpenny JM, et al. Optimizing emergency department front-end operations. Ann Emerg Med. In press.
  14. Chan TC, Killeen JP, Kelly D, et al. Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen. Ann Emerg Med. 2005;46:491–497
  15. Choi YF, Wong TW, Lau CC. Triage rapid initial assessment by doctor (TRIAD) improves waiting time and processing time of the emergency department. Emerg Med J. 2006;23:262–265; discussion 265
  16. Han JH, France DJ, Levin SR, et al. The effect of physician triage on emergency department length of stay. J Emerg Med. In press.
  17. Holroyd BR, Bullard MJ, Latoszek K, et al. Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trial. Acad Emerg Med. 2007;14:702–708
  18. Partovi SN, Nelson BK, Bryan ED, et al. Faculty triage shortens emergency department length of stay. Acad Emerg Med. 2001;8:990–995
  19. Subash F, Dunn F, McNicholl B, et al. Team triage improves emergency department efficiency. Emerg Med J. 2004;21:542–544
  20. Terris J, Leman P, O'Connor N, et al. Making an IMPACT on emergency department flow: improving patient processing assisted by consultant at triage. Emerg Med J. 2004;21:537–541
  21. Aronsky D, Jones I, Lanaghan K, et al. Supporting patient care in the emergency department with a computerized whiteboard system. J Am Med Inform Assoc. 2008;15:184–194
  22. Aronsky D, Johnston PE, Jenkins G, et al. The effect of implementing computerized provider order entry on medication prescribing errors in an emergency department. AMIA Annu Symp Proc. 2007;863
  23. Giuse DA. Supporting communication in an integrated patient record system. AMIA Annu Symp Proc. 2003;1065
  24. Tanabe P, Gimbel R, Yarnold PR, et al. Reliability and validity of scores on the Emergency Severity Index version 3. Acad Emerg Med. 2004;11:59–65
  25. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41–55
  26. Glynn RJ, Schneeweiss S, Sturmer T. Indications for propensity scores and review of their use in pharmacoepidemiology. Basic Clin Pharmacol Toxicol. 2006;98:253–259
  27. Hodges JL, Lehmann EL. Estimates of location based on rank tests. Ann Math Stat. 1963;34:598–611
  28. Efron B. Nonparametric standard errors and confidence intervals. Can J Stat. 1981;9:139–158

 Please see page 28 for the Editor's Capsule Summary of this article.

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editor: Donald M. Yealy, MD

 Author contributions: SR and RSD conceived and designed the study. SR performed the data analysis and statistics and drafted the initial article. IJ and DA created the data collection systems. IJ, DA, and CMS contributed substantially to data collection systems revision. IJ and CMS implemented the described intervention. SR takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Russ was supported by the Department of Veterans Affairs Office of Academic Affiliations, with resources of the VA–Tennessee Valley Healthcare System, Nashville, TN.

 Publication date: Available online March 16, 2010.

 Reprints not available from the authors.

PII: S0196-0644(10)00119-8

doi: 10.1016/j.annemergmed.2010.02.006

Annals of Emergency Medicine
Volume 56, Issue 1 , Pages 27-33 , July 2010