Background: Ongoing staffing shortages, high bed occupancy rates and post COVID changes are putting substantial strain not only on the inpatient environment, but also on the Emergency Department (ED). Increase in the number of boarded patients and length of boarding times pose risk to optimal patient care. Across the nation, the role of hospitalist as ED triagist has been emerging in optimizing safe hospital throughput.
Purpose: Our institution has been facing unprecedented capacity. ED triage pilot was created to assist with throughput and determine disposition of patients in a collaborative manner with the ED team. Hospitalist focus was on low medical acuity patients, who could potentially be stabilized and discharged from ED.
Description: A multidisciplinary team, consisting of hospitalists, ED physicians, nursing team, physical therapy (PT) and case management/social work (CM/SW), collaboratively created ED triage pilot. ED physicians were instructed to identify patients with low medical acuity, who could potentially receive medical care in ED and be discharged home after being treated by hospitalists, as well as patients who have no medical needs but need placement. Hospitalist would assume care of these patients, coordinating consultants and PT input, expediting imaging (stress tests, echocardiograms, etc). SW was present in ED, to assure a safe discharge plan, coordinating care with outside providers and home health agencies. Most common diagnoses on patients discharged from ED were chest pain, urinary tract infection, deep venous thrombosis/uncomplicated pulmonary embolism, acute asthma/COPD attack, generalized weakness. Initial ED pilot was observed for 12 days, resulting in 25 discharges, estimating an average save of 3 patient days per one discharge. The patients that were discharged were tracked for a month – none of them were readmitted. CM also provided follow up phone calls on discharged patients, and no concerns were identified on discharged patients. There was reduced effectiveness on throughput during the weekend due to lower patient volume and lack of social work support. Additionally, there was anecdotal qualitative feedback of increased camaraderie amongst the ED physician and hospitalist group. Unfortunately, due to hospitalist staffing issues, the triagist role could not continue, but given the success of this initial pilot, we plan to staff the triagist role once more staff is hired.
Conclusions: Hospitalist working in ED triagist roles are happening across the nation, with the nature of their role significantly varying from institution to institution. By establishing an ED triagist at our institution, with the support of a multidisciplinary team, we were able to discharge patients safely. In the future, we plan to do cost saving analysis, monitor median admit decision time to ED departure time (ED-2), ED LOS, hospital LOS and provider surveys.