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

Effects of Provider-at-Triage on Emergency Department Efficiency, Information Delivery and Patient Satisfaction

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.

Study Overview

• Status: Completed
• Conditions: Patient Satisfaction With Emergency Department Efficiency
• Intervention / Treatment: Other: Usual Care; Behavioral: Physician at triage

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.

• Study Type: Observational
• Enrollment (Actual): 439

Contacts and Locations

Study Locations

• United States
  • Florida
    • Gainesville, Florida, United States, 32608
      • UF Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 110 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Individuals receiving care from the Emergency Department between 10am-3pm on days a physician is (Monday-Wednesday) and is not (Thursday-Sunday) assigned to triage.

Description

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:

• Unwilling or unable to sign an informed consent
• In police custody
• Too ill to participate in study.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Usual Care; Group enrolled during normal emergency department operating procedures (without a physician present at triage).	Other: Usual Care; No physician at triage
Physician at Triage; Group enrolled while a physician is present at triage.	Behavioral: Physician at triage; A physician embedded at triage

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Satisfaction	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	60 minutes after Emergency Department triage

Secondary Outcome Measures

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

Collaborators and Investigators

• Sponsor: University of Florida
• Investigators: Principal Investigator: Brandon Allen, MD, Univeristy of Florida

Study record dates

Study Major Dates

• Study Start: October 1, 2015
• Primary Completion (Actual): March 1, 2016
• Study Completion (Actual): March 1, 2016

Study Registration Dates

• First Submitted: February 23, 2016
• First Submitted That Met QC Criteria: March 3, 2016
• First Posted (Estimate): March 9, 2016

Study Record Updates

• Last Update Posted (Actual): September 23, 2019
• Last Update Submitted That Met QC Criteria: September 19, 2019
• Last Verified: September 1, 2019

More Information

Terms related to this study

• Keywords: Patient Satisfaction; Emergency Department efficiency
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: IRB201500586

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No