Does Practice Match Protocol? A Comparison of Triage-to-Provider Time Among More vs. Less Acute Emergency Department...

Area of Science:

• Emergency Medicine
• Healthcare Operations
• Patient Flow Management

Background:

• The Emergency Severity Index (ESI) is crucial for stratifying patients in emergency departments (EDs).
• Split flow models in EDs separate less acute (ESI 4-5) and more acute (ESI 1-3) patients for distinct care pathways.
• A core principle of emergency medicine is prioritizing the most acute patients.

Purpose of the Study:

• To determine the percentage of less acute patients seen by a provider sooner than more acute patients who arrived closely together.
• To compare triage-to-provider times between fast track and acute care areas within the split flow model.

Main Methods:

• A random sample of 252 adult ED patients was analyzed.
• Data collected included ESI level, triage time, first provider sign-up time, and patient location (fast track vs. acute care).
• Paired patients with similar arrival times were compared based on ESI, location, and waiting times.

Main Results:

• In 39.4% of paired high- vs. low-acuity patients, the less acute patient was seen first.
• Patients in acute care areas generally had shorter triage-to-provider times than those in fast track areas.
• Approximately one-third of ESI 3 patients in fast track were seen before ESI 2 patients in acute care.

Conclusions:

• While split flow models improve ED efficiency, they may compromise the principle of prioritizing acute patients.
• A significant proportion of less acute patients are seen before more acute patients, potentially impacting urgent care.
• The fast track area may not be functioning as intended, with some patients experiencing longer waits than expected.