Emergency department front-end split-flow experience: ‘physician in intake’

[摘要] Background Emergency department (ED) crowding isa critical problem in the delivery of acute unscheduledcare. Many causes are external to the ED, but antiquatedoperational traditions like triage also contribute. Aphysician intake model has been shown to be beneficialin a single-centre study, but whether this solution isgeneralisable is not clear. We aimed to characterise thecurrent state of front-end intake models in a nationalsample of EDs and quantify their effects on throughputmeasures.Methods We performed a descriptive mixed-methodanalysis of ED process changes implemented by a crosssection of self-selecting institutions who reported 2 yearsof demographic/operational data and structured processdescriptions of any ‘new front-end processes to replacetraditional nurse-based triage’.Results Among 25 participating institutions, 19 (76%)provided data. While geographically diverse, most wereurban, academic adult level 1 trauma centres. Thirteen(68%) reported implementing a new intake process. Allwere run by attending emergency physicians, and six(46%) also included advanced practice providers. Dailyoperating hours ranged from 8 to 16 (median 12, IQR10.25–15.85), and the majority performed labs, imagingand medication administration and directly dischargedpatients. Considering each site’s before-and-after data asmatched pairs, physician-driven intake was associatedwith mean decreases in arrival-to-provider time of 25min(95%CI 13 to 37), ED length of stay 36min (95%CI 12 to59), and left before being seen rate 1.2% (95% CI 0.6% to1.8%).Conclusions In this cross section of primarily academicEDs, implementing a physician-driven front-end intakeprocess was feasible and associated with improvement inoperational metrics.

[学科分类] 药学