Emergency department length of stay: Does it matter who performs TeleTriage?

Emergency Department (ED) visits in the United States are increasing. Patients have to wait longer to be evaluated by clinicians. Telemedicine has been used to provide remote medical screening examination to initiate the triage process (TeleTriage) for ED patients. However, whether the types of TeleTriage clinicians (physician or Non-Physician Practitioners [NPP]) will influence patients' length of stay in the ED (EDLOS) is unknown. We hypothesized that there was no difference in EDLOS for patients TeleTriaged by physicians or NPPs.

This is a retrospective, multicenter study involving one academic and one community ED. All patients undergoing TeleTriage between January 1st to December 31st, 2023 at these 2 sites were eligible. We excluded patients who left without being seen or prior to completion of treatment, were discharged against medical advice, or presented with psychiatric complaints. Multivariable logistic regression was performed to assess clinical factor and outcome (EDLOS >6 h).

We analyzed 8145 patients, with mean (+/-SD) age of 47 (+/- 18) years and 44 % being male. A total of 4419 (54 %) patients were TeleTriaged by NPP, while 3726 (46 %) were TeleTriaged by a physician. Median [Interquartile (IQR)] EDLOS for NPP TeleTriaged patients were 739 [396-1463] minutes, compared with 528 [306-1070] minutes for physician-TeleTriaged group (difference 148, 95 % CI 126-171, P < 0.001). Multivariable logistic regression showed that patients presenting at evening 4 pm-10 pm shift (OR 1.2877, 95 % CI 1.04-1.58, P < 0.001), and to an academic ED (OR 1.52, 95 %CI 1.32-1.76, P < 0.001) were associated with longer EDLOS, while being triaged by physicians were associated with shorter EDLOS (OR 0.80, 95 %CI 0.69-0.91, P < 0.001).

Emergency patients who were TeleTriaged by physicians were associated with lower odds for EDLOS >6 h, when compared to those TeleTriaged by NPP. However, there are potentially other factors, besides types of clinicians, that may influence patients' EDLOS. Further studies are needed to investigate our observation.