Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department
Abstract
Introduction: Emergency department (ED) crowding is associated with detrimental effects on EDquality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding.Prior studies have evaluated attending physicians and advanced practice providers as TLPs, withlimited data evaluating resident physicians as TLPs. This study compares operational performanceoutcomes between resident and attending physicians as TLPs.
Methods: This retrospective cohort study compared aggregate operational performance at anurban, academic ED during pre- and post-TLP periods. The primary outcome was defined ascost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined asdifferences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of leftwithout being seen (LWBS), and proportion of “very good” overall patient satisfaction scores.
Results: Annual profit generated for physician-based collections through LWBS capture (afterdeducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss(ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable,with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time forresident TLPs was significantly lower (p<0.0001) than attending or historical control. Proportion of “verygood” patient satisfaction scores and LWBS was improved for both resident and attending TLPs overhistorical control. Overall median LOS was not significantly different.
Conclusion: Resident and attending TLPs improved DTP time, patient satisfaction, and LWBSrates. Both resident and attending TLPs are cost effective, with residents having a more favorablefinancial profile.