Does a Provider in Triage and Rapid Medical Evaluation Help With Left Without Being Seen Rates and ED Crowding?

Abstract

Introduction: Attempting to reduce ED crowding, the ED team at a rural academic medical center and specialty hospital implemented rapid medical evaluation (RME) with and without a provider in triage (PIT). The purpose of this performance improvement project was to explore how these interventions affected crowding metrics of door-to-disposition time, ED length of stay (LOS), and left without being seen (LWBS) rates for all patients.

Methods: Using a prospective 2-group design, the pre-RME population served as the historical control group, and postintervention groups included both RME with and without PIT. Group comparisons of crowding metrics included pre- and post-RME with and without PIT.

Results: There were no statistically significant differences in any of the crowding metrics for the emergency severity index (ESI) 3 groups pre- or post-RME. However, mean door-to-disposition times for the post-RME ESI 5 population were shorter compared with the pre-RME ESI 5 patients (2:59:23 vs. 2:00: 42; P = 0.037). Analysis of the post-RME population with and without PIT did not demonstrate significant differences across ESI 3 or 5 groups. Comparisons of post-RME data revealed a significant increase in ED LOS for all admitted patients regardless of their ESI (P = 0.023) and also door-to-disposition times for ESI level-4 patient groups, both with and without PIT (P = 0.022).

Implications for practice: The findings support other studies demonstrating that RME can have positive impact on ED crowding metrics for some patients. Although PIT took longer for some patients, anecdotal findings revealed benefits related to direct discharges and admission occurring during the RME process.

Keywords: ED crowding; Left without being seen; Physician in triage; Provider in triage; Rapid medical evaluation; Triage.