DEDICATED TRIAGE PHYSICIAN ASSISTANT IMPROVES EMERGENCY-INPATIENT ADMISSION THROUGHPUT

Tuyet-Trinh Truong, MD, Elisabeth Merson, PA-C, Maria Anaizza Aurora Reyna, Associate Chief Division of Hospital Medicine, Forest Hills, NY

Meeting: Hospital Medicine 2019, March 24-27, National Harbor, Md.

Abstract number: 429

Categories: Hospital Medicine 2019, Innovations, Transitions of Care

Keywords: , , ,

Background: The most acute patients presenting to the Emergency Department (ED) requirean admission to the inpatient setting. A timely triage and admission process
can improve the outcomes of these critically ill patients. Forty-six
percent of admissions through our ED are admitted across multiple
medicine services. We originally utilized a rotating Medical Admitting
Resident (MAR) to triage patients during nights and Saturdays, while
we used a dedicated Medical Admitting Physician Assistant (MAPA)
during the daytime and on Sundays. MAR triage was associated with
longer triage times and increased variability compared to those of the
MAPA. Additionally, the triage provider served as the intermediary between the
ER and inpatient team (IP) for information, which led to
miscommunication and delays in both triage and patient care.

Purpose: This project sought to improve triage time by streamlining the triage
process and to improve the sign-out process between the ED and IP
teams.

Description: An interdisciplinary ED-IM team was convened to map out all processes
and identify barriers to timely triage. A new model of triage was
established where all triage is done by dedicated and trained MAPAs
rather than a mix of MAR and MAPAs. They triage patients to IP
medicine teams by utilizing a new, standardized ED triage note,
service-specific criteria, and their clinical expertise. IP teams are
alerted by MAPAs of an admission and provided with ED contact
information. ED and IP teams then communicate directly for verbal
signout. Patient turnaround times from ED admit order to IP team
assignment 1 month pre- versus 1 month post-intervention were analyzed
for effectiveness of interventions.

Conclusions: By transitioning to this exclusive MAPA model and a streamlined triage
process with less verbal handoffs, the median time from ED admit order
to IP team assignment decreased from 36 to 20 minutes (44 %
reduction). ED residents reported more time with patients and decrease
in their time on the phone. Admitting teams were satisfied with direct
handoff from the ED and felt it solidified their knowledge of an
admitted patient, all improving patient safety while decreasing ED length
of stay.

To cite this abstract:

Truong, T; Merson, EL; Reyna, M. DEDICATED TRIAGE PHYSICIAN ASSISTANT IMPROVES EMERGENCY-INPATIENT ADMISSION THROUGHPUT. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 429. https://www.shmabstracts.com/abstract/dedicated-triage-physician-assistant-improves-emergency-inpatient-admission-throughput/. Accessed August 24, 2019.

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