Team triage increases discharges and decreases time to discharge without increasing test ordering

Samita M Heslin; Arie Francis; Richard Cloney; Gina Marie Polizzo; Karen Scott; Candice King; Peter Viccellio; Alison L Rowe; Eric J Morley

doi:10.1002/emp2.12311

Team triage increases discharges and decreases time to discharge without increasing test ordering

J Am Coll Emerg Physicians Open. 2021 Feb 11;2(1):e12311. doi: 10.1002/emp2.12311. eCollection 2021 Feb.

Authors

Samita M Heslin¹, Arie Francis¹, Richard Cloney¹, Gina Marie Polizzo¹, Karen Scott¹, Candice King¹, Peter Viccellio¹, Alison L Rowe¹, Eric J Morley¹

Affiliation

¹ Department of Emergency Medicine Renaissance School of Medicine at Stony Brook University Stony Brook New York USA.

Abstract

Objectives: Emergency department (ED) crowding is detrimental to patients and staff. During traditional triage, nurses evaluate patients and identify their level of emergency. During team triage, physicians and/or nurse practitioners (NPs) and physician assistants (PAs) place orders, laboratory results, intravenous lines (IVs), and imaging in triage. Team triage improves access to testing and decreases length of stay. However, ordering practices in team triage may lead to overtesting.

Methods: This is a retrospective review of patients seen before and after a team triage process was established. Percentage of patients receiving testing and the diagnostic yields of troponins, lactates, international normalized ratios (INRs), blood cultures, glomerular filtration rates (GFR), and head computed tomography (CT) images were studied.

Results: A total of 704 traditionally triaged patients and 862 team triaged patients met inclusion criteria. Comparing traditional versus team triaged patients, the proportion of patients discharged was 0.44 versus 0.53 (P < 0.001), and the length of stay to discharge was 417 versus 375 minutes (P = 0.003). Comparing traditional versus team triage, a head CT was obtained 12.5% versus 5.7% (P < 0.001) of the time with diagnostic yield 45.5% versus 52% (not significant), troponin was obtained 51.3% versus 45.9% (not significant) of the time with diagnostic yield 14.9% versus 13.9% (not significant), lactate was obtained 41.6% versus 32.1% (P = 0.011) of the time with diagnostic yield 18.4% versus 12.3% (not significant), INR was obtained 70.2% versus 55.8% (P = 0.007) of the time with diagnostic yield 15.8% versus 10.5% (P = 0. 042), GFR was obtained 99.3% versus 98.4% (not significant) of the time with diagnostic yield 18.9% versus 13.7% (P = 0.02), and blood cultures were obtained 23.4% versus 7.3% (P < 0.001) of the time with diagnostic yield 7.3% versus 9.3% (not significant).

Conclusion: Compared with traditional triage, the team triage process increased discharges and decreased time to discharge, but did not lead to increased testing or decreased diagnostic yield.