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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2012

Open Access 01-12-2012 | Review

Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models

Authors: Lena Burström, Martin Nordberg, Göran Örnung, Maaret Castrén, Tony Wiklund, Marie-Louise Engström, Mats Enlund

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2012

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Abstract

Background

The management of emergency departments (EDs) principally involves maintaining effective patient flow and care. Different triage models are used today to achieve these two goals. The aim of this study was to compare the performance of different triage models used in three Swedish EDs. Using efficiency and quality indicators, we compared the following triage models: physician-led team triage, nurse first/emergency physician second, and nurse first/junior physician second.

Methods

All data of patients arriving at the three EDs between 08:00- and 21:00 throughout 2008 were collected and merged into a database. The following efficiency indicators were measured: length of stay (LOS) including time to physician, time from physician to discharge, and 4-hour turnover rate. The following quality indicators were measured: rate of patients left before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days.

Results

Data from 147,579 patients were analysed. The median length of stay was 158 minutes for physician-led team triage, compared with 243 and 197 minutes for nurse/emergency physician and nurse/junior physician triage, respectively (p < 0.001). The rate of patients left before treatment was completed was 3.1% for physician-led team triage, 5.3% for nurse/emergency physician, and 9.6% for nurse/junior physician triage (p < 0.001). Further, the rates of unscheduled return within 24 hours were significantly lower for physician-led team triage, 1.0%, compared with 2.1%, and 2.5% for nurse/emergency physician, and nurse/junior physician, respectively (p < 0.001). The mortality rate within 7 days was 0.8% for physician-led team triage and 1.0% for the two other triage models (p < 0.001).

Conclusions

Physician-led team triage seemed advantageous, both expressed as efficiency and quality indicators, compared with the two other models.
Appendix
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Metadata
Title
Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models
Authors
Lena Burström
Martin Nordberg
Göran Örnung
Maaret Castrén
Tony Wiklund
Marie-Louise Engström
Mats Enlund
Publication date
01-12-2012
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1757-7241-20-57

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