Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
Use of Physician-in-Triage Model in the Management of Abdominal Pain in an Emergency Department Observation Unit
- Author(s): Marshall, MD, John R
- Katzer, MD MBA, Robert
- Lotfipour, MD MPH, Shahram
- Chakravarthy, MD MPH, Bharath
- Shastry, MD, Siri
- Andrusaitis, Jessica
- Anderson, PhD, Craig L
- Barton, MD MS MBA, Erik D
- et al.
Published Web Locationhttps://doi.org/10.5811/westjem.2016.10.32042
With a nationwide increase in Emergency Department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study is to determine whether there is a significant difference in hospital admission rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an emergency department observation unit (EDOU) under an abdominal pain protocol by a physician-in-triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission).
This was a retrospective cohort study of patients admitted to a protocol driven EDOU with a diagnosis of abdominal pain in a single university hospital center ED. Compiled data was obtained for all patients admitted to the EDOU with a diagnosis of abdominal pain that met EDOU protocol admission criteria. Data for each cohort was then divided into age, gender, payer status, and LOS. This data was then analyzed to assess any significant differences between the cohorts.
There were 327 total patients eligible for this study (85 physician-in-triage group, 242 traditional ED group). The total success rate (defined as discharge home) was 90.8% (n=297) and failure rate (defined as admission or transfer) was 9.2% (n= 30). There were no significant differences observed in success rates between those dispositioned to the EDOU by physicians-in-triage (90.6%) versus via the traditional route (90.5 % p) = 0.98. There was also a significant difference found between the two groups regarding total LOS with significantly shorter main ED times and EDOU times amongst patients sent to the EDOU by the physician-in- triage group (p<.001).
There were no significant differences in EDOU disposition outcomes in patients admitted to an EDOU by a physician-in-triage or via the traditional route. Also, there were statistically significant shorter LOSs in patients admitted to the EDOU by triage physicians. The data from this study supports the implementation of a physician-in-triage model in combination with the EDOU in improving efficiency in the treatment of abdominal pain. This knowledge may act to cut healthcare costs, and improve patient flow and timely decision making in hospitals with EDOUs.