Triage assessment by physician assistants improves quality of care in the Emergency Department

In the Triage-Treat-and-Release (TTR) program, physician assistants (PAs) replaced nurses to triage all incoming patients in one emergency department (ED) of a busy inner city hospital in the United States. Once triaged, these fast-track patients received immediate treatment in the same room by the same PA who triaged them and were discharged without the patient ever entering the main ED. The combination of PA licensure, an explicit TTR protocol manual, and direct supervision by an ED physician gave this program clinical effectiveness.

TTR was successful at reducing time to provider, overall length of stay, and walkout rate. The door-to-provider time for all ED patients improved from 89 minutes before TTR to 33 minutes after TTR implementation. Overall length of stay for fast-track patients improved from 4 hr 35 min to 1 hr 47 min.

TTR was implemented without large increases in staffing at a time when ED patient volume was increasing markedly. The improvement it showed in typical measures of quality was similar to or better than that of other published studies. In light of the current nursing shortage, busy ED's may wish to consider implementing this model.