Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department

David M. Nestler, Alesia R. Fratzke, Christopher J. Church, Lori Scanlan-Hanson, Annie T. Sadosty, Michael P. Halasy, Janet L. Finley, Andy Boggust, Erik P. Hess

Research output: Contribution to journalArticle

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Abstract

Objectives Overcapacity issues plague emergency departments (EDs). Studies suggest that triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs. We evaluated whether a physician assistant (PA), acting as a TLP, would shorten LOS and decrease LWBS rates. Methods The authors used an observational cohort controlled before-and-after study design with predefined outcome measures, comparing 8 pilot days to 8 control days. The TLP evaluated all Emergency Severity Index (ESI) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients. Results A total of 353 patients were included on pilot days and 371 on control days. LOS was shorter on pilot days than control days (median [interquartile range {IQR}] = 229 [168 to 303] minutes vs. 270 [187 to 372] minutes, p < 0.001). Waiting room times were similar between pilot and control days (median [IQR] = 69 [20 to 119] minutes vs. 70 [19 to 137] minutes, p = 0.408), but treatment room times were shorter (median [IQR] = 151 [92 to 223] minutes vs. 187 [110 to 254] minutes, p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4% vs. 9.7%, p < 0.001). Conclusions The addition of a PA as a TLP was associated with a 41-minute decrease in median total LOS and a lower proportion of patients who LWBS. The decrease in total LOS is likely attributable to the addition of the TLP, with patients having shorter duration in treatment rooms on pilot days compared to control days.

Original languageEnglish (US)
Pages (from-to)1235-1241
Number of pages7
JournalAcademic Emergency Medicine
Volume19
Issue number11
DOIs
StatePublished - Nov 2012

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Physician Assistants
Triage
Hospital Emergency Service
Length of Stay
Plague
Emergencies
Outcome Assessment (Health Care)
Pediatrics
Physicians
Health
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Nestler, D. M., Fratzke, A. R., Church, C. J., Scanlan-Hanson, L., Sadosty, A. T., Halasy, M. P., ... Hess, E. P. (2012). Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department. Academic Emergency Medicine, 19(11), 1235-1241. https://doi.org/10.1111/acem.12010

Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department. / Nestler, David M.; Fratzke, Alesia R.; Church, Christopher J.; Scanlan-Hanson, Lori; Sadosty, Annie T.; Halasy, Michael P.; Finley, Janet L.; Boggust, Andy; Hess, Erik P.

In: Academic Emergency Medicine, Vol. 19, No. 11, 11.2012, p. 1235-1241.

Research output: Contribution to journalArticle

Nestler, DM, Fratzke, AR, Church, CJ, Scanlan-Hanson, L, Sadosty, AT, Halasy, MP, Finley, JL, Boggust, A & Hess, EP 2012, 'Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department', Academic Emergency Medicine, vol. 19, no. 11, pp. 1235-1241. https://doi.org/10.1111/acem.12010
Nestler, David M. ; Fratzke, Alesia R. ; Church, Christopher J. ; Scanlan-Hanson, Lori ; Sadosty, Annie T. ; Halasy, Michael P. ; Finley, Janet L. ; Boggust, Andy ; Hess, Erik P. / Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department. In: Academic Emergency Medicine. 2012 ; Vol. 19, No. 11. pp. 1235-1241.
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abstract = "Objectives Overcapacity issues plague emergency departments (EDs). Studies suggest that triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs. We evaluated whether a physician assistant (PA), acting as a TLP, would shorten LOS and decrease LWBS rates. Methods The authors used an observational cohort controlled before-and-after study design with predefined outcome measures, comparing 8 pilot days to 8 control days. The TLP evaluated all Emergency Severity Index (ESI) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients. Results A total of 353 patients were included on pilot days and 371 on control days. LOS was shorter on pilot days than control days (median [interquartile range {IQR}] = 229 [168 to 303] minutes vs. 270 [187 to 372] minutes, p < 0.001). Waiting room times were similar between pilot and control days (median [IQR] = 69 [20 to 119] minutes vs. 70 [19 to 137] minutes, p = 0.408), but treatment room times were shorter (median [IQR] = 151 [92 to 223] minutes vs. 187 [110 to 254] minutes, p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4{\%} vs. 9.7{\%}, p < 0.001). Conclusions The addition of a PA as a TLP was associated with a 41-minute decrease in median total LOS and a lower proportion of patients who LWBS. The decrease in total LOS is likely attributable to the addition of the TLP, with patients having shorter duration in treatment rooms on pilot days compared to control days.",
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AU - Sadosty, Annie T.

AU - Halasy, Michael P.

AU - Finley, Janet L.

AU - Boggust, Andy

AU - Hess, Erik P.

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N2 - Objectives Overcapacity issues plague emergency departments (EDs). Studies suggest that triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs. We evaluated whether a physician assistant (PA), acting as a TLP, would shorten LOS and decrease LWBS rates. Methods The authors used an observational cohort controlled before-and-after study design with predefined outcome measures, comparing 8 pilot days to 8 control days. The TLP evaluated all Emergency Severity Index (ESI) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients. Results A total of 353 patients were included on pilot days and 371 on control days. LOS was shorter on pilot days than control days (median [interquartile range {IQR}] = 229 [168 to 303] minutes vs. 270 [187 to 372] minutes, p < 0.001). Waiting room times were similar between pilot and control days (median [IQR] = 69 [20 to 119] minutes vs. 70 [19 to 137] minutes, p = 0.408), but treatment room times were shorter (median [IQR] = 151 [92 to 223] minutes vs. 187 [110 to 254] minutes, p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4% vs. 9.7%, p < 0.001). Conclusions The addition of a PA as a TLP was associated with a 41-minute decrease in median total LOS and a lower proportion of patients who LWBS. The decrease in total LOS is likely attributable to the addition of the TLP, with patients having shorter duration in treatment rooms on pilot days compared to control days.

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