ABSTRACT Study Objective Provider‐in‐Triage (PIT) models can mitigate emergency department (ED) crowding. However, PIT models have been shown to reduce resident productivity and increase the acuity of patients seen by residents. The reasons for these shifts are not well described. We sought to describe the acuity and diagnostic complexity of patients dispositioned through PIT. Methods We conducted a retrospective chart review of patients seen and dispositioned through PIT without resident involvement at an urban, academic ED between July 9, 2023, and July 8, 2024. Extracted data elements included Emergency Severity Index (ESI) acuity, encounter duration, diagnostic testing, procedures, consultant involvement, and clinical impressions categorized according to the American Board of Emergency Medicine Model of Clinical Practice (ABEM MOCP). Descriptive statistics were used to summarize cohort characteristics, and a Wilcoxon rank sum test was used to compare ESI scores of PIT patients with the overall ED population. Results Among 65,224 ED visits, 746 (1.1%) patients were dispositioned through PIT. Their mean ESI was not significantly different from the overall population (2.75 vs. 2.80; p = 0.53). Most patients were discharged ( n = 694, 93%). Diagnostic workups were frequent with 75% ( n = 559) receiving labs and 19% ( n = 142) having advanced imaging. The top 3 most common ABEM MOCP categories included Abdominal & Gastrointestinal, Traumatic, and Cardiovascular Disorders. Conclusion In our PIT model, PIT‐dispositioned patients demonstrated similar acuity to the general ED population and presented with complaints of diagnostic complexity necessitating evaluation with labs, imaging, and advanced imaging. In academic centers, educators should work closely with ED operations to optimize the educational impact of PIT.
Hill et al. (Mon,) studied this question.
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