The effect of provider level triage in a military treatment facility emergency department

Abstract

Introduction Studies show that patients who spend more than 2 hours in the emergency department (ED) report more dissatisfaction with their visits. To remedy this situation, several EDs have implemented programs that insert a medical provider into triage. The objective of this study was to determine whether a Physician Assistant (PA) and Combat Medic performing triage care during peak hours could increase patient throughput. Methods This study is a comparative analysis. We implemented an Emergency Department Provider Level Triage Team (PLTT) that consisted of 1 Emergency Medicine Physician Assistant and 1 Combat Medic to intervene in patient care in the ED at Womack Army Medical Center (WAMC), Fort Bragg, North Carolina, USA. Three days of 12 hours shifts were selected during the peak hours of the ED and compared to the same period on days that did not have the intervention. Only patients categorized with an Emergency Severity Index of 2 or 3 were selected and compared. No additional medical, nursing and medic staff were used. This study was approved by the WAMC Institutional Review Board. Results In total, there were 241 cases during the trial period and 231 controls. Median times were significantly reduced (p=<0.001) during the intervention period. Times to analgesia (97.4 min v 171.1 min, p=0.03), time to laboratory results (103.8 min v 143.9 min, p=0.01), radiology (136.3 min v 181.6 min, p=<0.001), and to disposition (317.4 min v 334.6 min, p=0.05) were all decreased. Nearly 90% of patients in the intervention group said that their experience with the intervention was very good or outstanding. Conclusion The implementation of the PLTT model in our ED was associated with reduced time to healthcare provider assessment, decreased overall ED length of stay, and improved patient satisfaction.