Faculty triage shortens emergency department length of stay

Objective: To determine whether faculty triage (FT) activities can shorten emergency department (ED) length of stay (LOS). Methods: This was a compari son study measuring the impact of faculty triage vs no faculty triage on ED LOS. It was set in an urban county teaching hospital. Subjects were patien ts presenting to the registration desk between 9 AM and 9 PM on 16 consecut ive Mondays (August 2 to November 15, 1999). On eight Mondays, an additiona l faculty member was stationed at the triage desk. He or she was asked to e xpedite care by rapid evaluation orders for diagnostic studies and basic th erapeutic interventions, and by moving serious patients to the patient care areas. He or she was not provided with detailed instructions or protocols. The ED LOS, time of registration (TIMEREG), inpatient admission status (AD MIT), x-ray utilization (XRAY), total patients registered each day between 9 Am and 9 PM (TOTREG), and patients who left without being seen (LWBS) wer e determined using an ED information system. The LOS was analyzed in relati on to FT, ADMIT, and XRAY by the Mann-Whitney U test. The LOS was related t o TIMEREG and TOTREG by simple linear regression. Stepwise multiple linear regression models to predict LOS were generated using all the variables. Re sults: Patients without FT (n = 814) had a mean LOS of 445 minutes. Patient s with FT (n = 920) had a mean LOS of 363 minutes. Mean difference in LOS w as -82 minutes (95% CI = -111 to -53), a reduction of 18%. The LOS was also related to: ADMIT +203 minutes (95% Cl = 168 to 238), TOTREG -2.7 min/addi tional patient registered (95% CI = -1.15 to -4.3), and TIMEREG +0.14 min/m in since 9 Am (95% Cl = 0.07 to 0.21). The LWBS was reduced by 46% with FT. In multiple regression analysis, ADMIT, FT, TIMEREG, and XRAY were all rel ated to LOS, but the model explained only a small part of variance (adjuste d R-2 = 0.093). The faculty cost is estimated to be $11.98/patient. Conclus ions: Faculty triage offers a moderate increase in efficiency at this ED, a lbeit with relatively high cost.