Role of Provider-at-Triage on ED Efficiency and Quality of Care

Completed

Brief Summary: The United States spends over $8,000 per capita annually on health care and its health care system is more expensive than other developed countries. Even with high per capita costs and a high proportion of physician specialists, the US lags in health care performance from patients' perspectives.

The hospital emergency department (ED) is often the portal of entry for patients seeking health care services and is therefore an ideal setting for initiatives to improve efficiency of care delivery and patient satisfaction. Reduction in wait times, enhanced information delivery and ED staff service quality all have a positive influence on patient perception of health care quality and satisfaction.

Prior studies have attempted to increase patient satisfaction by improving staff communication and courtesy, implementing a patient satisfaction team in triage, and delivering information to patients in a timely manner. Another strategy to increase the efficiency of ED operations is adding a physician to triage to perform brief medical screenings and initiate necessary patient testing and treatment. This contrasts to usual practice in which physicians evaluate patients only following registration and nurse assessment of illness or injury severity.

Detailed Description: This study will assess the impact of early patient assessment by a physician at Emergency Department (ED) triage on patient perception of information delivery, overall patient satisfaction and ED efficiency. ED efficiency will be assessed by ED length of patient stay, ED left-without-being-seen and ED left during treatment rates.

Participants who decide to take part in this study, will be asked questions by research staff, who will document responses on a secure iPAD device. The survey will ask participants how they feel about their health condition, the emergency department wait, the care they received in the emergency department and how satisfied the participant was with the care received.

Recruitment & Eligibility

Inclusion Criteria

Participants are eligible to participate in the study if they are:

English speaking
Without hemodynamic or respiratory compromise
Do not have a nurse-assigned triage severity score of Emergency Severity Index 1 (most severe illness or injury score).

Exclusion Criteria

Participants will be excluded if they are:

Arm && Interventions

Group	Intervention	Description
Physician at Triage	Physician at triage	Group enrolled while a physician is present at triage.
Usual Care	Usual Care	Group enrolled during normal emergency department operating procedures (without a physician present at triage).

Primary Outcome Measures

Name	Time	Method
Patient Satisfaction	60 minutes after Emergency Department triage	Patient Satisfaction Score- brief survey measured on a Likert Scale * 1= Never * 2= Sometimes * 3= Usually * 4= Always * 5= Not applicable - I did not see a doctor today

Secondary Outcome Measures

Name	Time	Method
Emergency Department efficiency	24 hours after ED triage in minutes	Impact of physician at triage on ED length of stay rates
Left without being seen rate	12 hours after ED triage in minutes	Impact of physician at triage on left without being seen rate

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