Emergency department rapid medical assessment: Overall effect and mechanistic considerations

Stephen Traub, Joseph P. Wood, James Kelley, David M. Nestler, Yu Hui Chang, Soroush Saghafian, Christopher A. Lipinski

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Although the use of a physician and nurse team at triage has been shown to improve emergency department (ED) throughput, the mechanism(s) by which these improvements occur is less clear. Objectives 1) To describe the effect of a Rapid Medical Assessment (RMA) team on ED length of stay (LOS) and rate of left without being seen (LWBS); 2) To estimate the effect of RMA on different groups of patients. Methods For Objective 1, we compared LOS and LWBS on dates when we utilized RMA to comparable dates when we did not. For Objective 2, we utilized patient logs to divide patients into groups and estimated the effects of the RMA on each. Results Objective 1. LOS fell from 297.8 min pre-RMA to 261.7 min during RMA, an improvement of 36.1 (95% confidence interval 21.8-50.4) min; LWBS did not change significantly. Objective 2. Patients seen and dispositioned by the RMA had an estimated decrease in LOS of 117.8 min (estimated decrease in LOS of 45%), but patients seen by the RMA whose care was transitioned to the main ED had an estimated increase in LOS of 25.0 min (estimated increase in LOS of 8%). Conclusions On a system level, the addition of an RMA shift at a single facility was associated with an improvement in LOS, but not LWBS. On a mechanistic level, it seems that improvements occurred as a result of the rapid disposition component of the RMA rather than placing advanced orders at triage.

Original languageEnglish (US)
Pages (from-to)620-627
Number of pages8
JournalJournal of Emergency Medicine
Volume48
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Hospital Emergency Service
Length of Stay
Triage
Nurses
Confidence Intervals
Physicians

Keywords

  • advanced triage
  • physician in triage
  • rapid medical assessment
  • throughput

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Traub, S., Wood, J. P., Kelley, J., Nestler, D. M., Chang, Y. H., Saghafian, S., & Lipinski, C. A. (2015). Emergency department rapid medical assessment: Overall effect and mechanistic considerations. Journal of Emergency Medicine, 48(5), 620-627. https://doi.org/10.1016/j.jemermed.2014.12.025

Emergency department rapid medical assessment : Overall effect and mechanistic considerations. / Traub, Stephen; Wood, Joseph P.; Kelley, James; Nestler, David M.; Chang, Yu Hui; Saghafian, Soroush; Lipinski, Christopher A.

In: Journal of Emergency Medicine, Vol. 48, No. 5, 01.05.2015, p. 620-627.

Research output: Contribution to journalArticle

Traub, Stephen ; Wood, Joseph P. ; Kelley, James ; Nestler, David M. ; Chang, Yu Hui ; Saghafian, Soroush ; Lipinski, Christopher A. / Emergency department rapid medical assessment : Overall effect and mechanistic considerations. In: Journal of Emergency Medicine. 2015 ; Vol. 48, No. 5. pp. 620-627.
@article{b2004603af3447c68cfff32c98bdfd37,
title = "Emergency department rapid medical assessment: Overall effect and mechanistic considerations",
abstract = "Background Although the use of a physician and nurse team at triage has been shown to improve emergency department (ED) throughput, the mechanism(s) by which these improvements occur is less clear. Objectives 1) To describe the effect of a Rapid Medical Assessment (RMA) team on ED length of stay (LOS) and rate of left without being seen (LWBS); 2) To estimate the effect of RMA on different groups of patients. Methods For Objective 1, we compared LOS and LWBS on dates when we utilized RMA to comparable dates when we did not. For Objective 2, we utilized patient logs to divide patients into groups and estimated the effects of the RMA on each. Results Objective 1. LOS fell from 297.8 min pre-RMA to 261.7 min during RMA, an improvement of 36.1 (95{\%} confidence interval 21.8-50.4) min; LWBS did not change significantly. Objective 2. Patients seen and dispositioned by the RMA had an estimated decrease in LOS of 117.8 min (estimated decrease in LOS of 45{\%}), but patients seen by the RMA whose care was transitioned to the main ED had an estimated increase in LOS of 25.0 min (estimated increase in LOS of 8{\%}). Conclusions On a system level, the addition of an RMA shift at a single facility was associated with an improvement in LOS, but not LWBS. On a mechanistic level, it seems that improvements occurred as a result of the rapid disposition component of the RMA rather than placing advanced orders at triage.",
keywords = "advanced triage, physician in triage, rapid medical assessment, throughput",
author = "Stephen Traub and Wood, {Joseph P.} and James Kelley and Nestler, {David M.} and Chang, {Yu Hui} and Soroush Saghafian and Lipinski, {Christopher A.}",
year = "2015",
month = "5",
day = "1",
doi = "10.1016/j.jemermed.2014.12.025",
language = "English (US)",
volume = "48",
pages = "620--627",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Emergency department rapid medical assessment

T2 - Overall effect and mechanistic considerations

AU - Traub, Stephen

AU - Wood, Joseph P.

AU - Kelley, James

AU - Nestler, David M.

AU - Chang, Yu Hui

AU - Saghafian, Soroush

AU - Lipinski, Christopher A.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background Although the use of a physician and nurse team at triage has been shown to improve emergency department (ED) throughput, the mechanism(s) by which these improvements occur is less clear. Objectives 1) To describe the effect of a Rapid Medical Assessment (RMA) team on ED length of stay (LOS) and rate of left without being seen (LWBS); 2) To estimate the effect of RMA on different groups of patients. Methods For Objective 1, we compared LOS and LWBS on dates when we utilized RMA to comparable dates when we did not. For Objective 2, we utilized patient logs to divide patients into groups and estimated the effects of the RMA on each. Results Objective 1. LOS fell from 297.8 min pre-RMA to 261.7 min during RMA, an improvement of 36.1 (95% confidence interval 21.8-50.4) min; LWBS did not change significantly. Objective 2. Patients seen and dispositioned by the RMA had an estimated decrease in LOS of 117.8 min (estimated decrease in LOS of 45%), but patients seen by the RMA whose care was transitioned to the main ED had an estimated increase in LOS of 25.0 min (estimated increase in LOS of 8%). Conclusions On a system level, the addition of an RMA shift at a single facility was associated with an improvement in LOS, but not LWBS. On a mechanistic level, it seems that improvements occurred as a result of the rapid disposition component of the RMA rather than placing advanced orders at triage.

AB - Background Although the use of a physician and nurse team at triage has been shown to improve emergency department (ED) throughput, the mechanism(s) by which these improvements occur is less clear. Objectives 1) To describe the effect of a Rapid Medical Assessment (RMA) team on ED length of stay (LOS) and rate of left without being seen (LWBS); 2) To estimate the effect of RMA on different groups of patients. Methods For Objective 1, we compared LOS and LWBS on dates when we utilized RMA to comparable dates when we did not. For Objective 2, we utilized patient logs to divide patients into groups and estimated the effects of the RMA on each. Results Objective 1. LOS fell from 297.8 min pre-RMA to 261.7 min during RMA, an improvement of 36.1 (95% confidence interval 21.8-50.4) min; LWBS did not change significantly. Objective 2. Patients seen and dispositioned by the RMA had an estimated decrease in LOS of 117.8 min (estimated decrease in LOS of 45%), but patients seen by the RMA whose care was transitioned to the main ED had an estimated increase in LOS of 25.0 min (estimated increase in LOS of 8%). Conclusions On a system level, the addition of an RMA shift at a single facility was associated with an improvement in LOS, but not LWBS. On a mechanistic level, it seems that improvements occurred as a result of the rapid disposition component of the RMA rather than placing advanced orders at triage.

KW - advanced triage

KW - physician in triage

KW - rapid medical assessment

KW - throughput

UR - http://www.scopus.com/inward/record.url?scp=84929131134&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929131134&partnerID=8YFLogxK

U2 - 10.1016/j.jemermed.2014.12.025

DO - 10.1016/j.jemermed.2014.12.025

M3 - Article

C2 - 25769939

AN - SCOPUS:84929131134

VL - 48

SP - 620

EP - 627

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

IS - 5

ER -