The Hospitalist Triage Role for Reducing Admission Delays: Impacts on Throughput, Quality, Interprofessional Practice, and Clinician Experience of Care

Background: Emergency department (ED) crowding is associated with deleterious consequences for patient care and throughput.Admission delays worsen ED crowding.Time to admission (TTA)-the time between an ED admission request and internal medicine (IM) admission orders-can be shortened through implementation of a triage hospitalist role.Limited research is available highlighting the impact of triage hospitalists on throughput, care quality, interprofessional practice, and clinician experience of care.Methods: A triage hospitalist role was piloted and implemented.Run charts were interpreted using accepted rules for deriving statistically significant conclusions.Statistical analysis was applied to interprofessional practice and clinician experienceof-care survey results.Results: Following implementation, TTA decreased from 5 hours 19 minutes to 2 hours 8 minutes.Emergency department crowding increased from baseline.The reduction in TTA was associated with decreased time from ED arrival to IM admission request, no change in critical care transfers during the initial 24 hours, and increased admissions to inpatient status.Additionally, decreased TTA was associated with no change in referring hospital transfer rates and no change in hospital medicine length of stay.Interprofessional practice attitudes improved among ED clinicians but not IM clinicians.Clinician experience-of-care results were mixed. Conclusion:A triage hospitalist role is an effective approach for mitigating admission delays, with no evident adverse clinical consequences.A triage hospitalist alone was incapable of resolving ED crowding issues without a complementary focus on downstream bottlenecks.