205358 Triage assessment by physician assistants improves quality of care in the Emergency Department

Monday, November 9, 2009

Kell N. Julliard, MA , Clinical Research Office, Lutheran Medical Center, Brooklyn, NY
Bonnie Simmons, DO , Emergency Department, Lutheran Medical Center, Brooklyn, NY
Claudia Caine, MPA , Executive Office, Lutheran Medical Center, Brooklyn, NY
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.

Learning Objectives:
Describe how an Emergency Department can be reorganized so that physician assistants can triage, treat, and release appropriate patients, decreasing length of stay and wait times without increasing staffing.

Keywords: Quality Improvement, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I analyzed data and wrote the paper for the project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.