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Related Experiment Videos

Emergency department front-end split-flow experience: 'physician in intake'.

Sean S Michael1, Daniel Bickley2, Kelly Bookman1

  • 1Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.

BMJ Open Quality
|December 5, 2019
PubMed
Summary

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Implementing physician-driven intake in emergency departments (EDs) improved patient flow. This model reduced wait times and the rate of patients leaving before being seen, enhancing ED operational efficiency.

Area of Science:

  • Health Services Research
  • Emergency Medicine
  • Healthcare Operations

Background:

  • Emergency department (ED) crowding is a significant barrier to acute unscheduled care delivery.
  • While external factors contribute, internal operational practices, such as traditional nurse-based triage, can exacerbate crowding.
  • The generalizability of physician intake models, previously studied in single centers, requires further investigation.

Purpose of the Study:

  • To characterize the current implementation of front-end intake models in a national sample of EDs.
  • To quantify the impact of physician-driven intake on ED throughput measures.

Main Methods:

  • A descriptive mixed-methods analysis was conducted on data from self-selecting institutions.
  • Participating sites reported 2 years of demographic/operational data and described new front-end processes replacing traditional triage.
Keywords:
emergency departmenthealthcare quality improvementimplementation sciencemanagementteamwork

Related Experiment Videos

  • Analysis included 19 of 25 participating institutions, primarily urban, academic adult level 1 trauma centers.

    • Main Results:

    • Physician-driven intake was implemented in 13 (68%) of participating EDs, with most run by attending emergency physicians.
    • Physician-driven intake was associated with a mean decrease in arrival-to-provider time of 25 minutes.
    • Significant improvements were observed in ED length of stay (36 minutes reduction) and a decrease in the left-before-being-seen rate (1.2%).

    Conclusions:

    • Implementing physician-driven front-end intake processes is feasible in academic ED settings.
    • This model demonstrated significant improvements in key operational metrics, including patient throughput and wait times.
    • Findings suggest physician-driven intake can be an effective strategy to mitigate ED crowding and improve efficiency.