Describe variance in ED throughput times.
Analyze teletriage effect on throughput times.
Recognize clinically relevant information to improve quality and safety.
Purpose: to examine the effect of teletriage intervention on ‘door to doc’ and ‘door to decision’ to admit or discharge, per acuity 5-level Emergency Severity Index (ESI) level and per illness grouping.
Observational Matched Case Control
The sample of Teletriage was composed of 165 cases. The cases were paired with non Teletriage controls based on admitting diagnosis, ED acuity, age (±5 years) and gender. Up to 3 controls were paired with each Teletriage case. A total of 22 Teletriage cases could not be paired with controls. The resulting sample was made of n = 143 Teletriage cases matched with a total of n = 273 controls. After the pairing of cases and controls, the admitting diagnosis was grouped into categories by frequency. The frequency of each category for the Teletriage group follows what is normally seen in the ED; the majority of Teletriage cases were either abdominal pain or chest pain. Generalized linear modeling analysis was utilized to test the difference in mean ‘door to doc’ and ‘door to decision’ time between both groups, adjusting for the matching variables.
We analyzed the whole sample together as well as the illness category to determine if the mean ‘door to doc’ times were shorter in the Teletriage group compared to the regular triage. Teletriage mean ‘door to doc’ time was 100 minutes and 119 minutes in control. Overall, the ‘door to doc’ was significantly shorter by an average of ~20 minutes for the Teletriage group (F (1,407df) = 4.45, p = 0.0356). In the analyses by illness grouping, the chest & epigastric pain category showed significant differences between the groups (F(1,139df) = 9.21, p = 0.0029) by more than ~47 minutes shorter in the Teletriage group. There were no significant differences between the Teletriage and regular triage groups for ‘door to decision’; however, a decrease in the overall ‘door to decision’ time by ~21 minutes and chest & epigastric pain category ‘door to decision’ time by ~19 minutes was observed.
Teletriage significantly benefited overall door to doc time and showed positive gains in door to decision times for the following categories: other pain by 32 & 80, head & neck by 16 &107, other injuries by 37 & 45, nausea & vomiting by 6 & 6, uncategorized by 27 & 57. Teletriage provides significant gains in reduction of door to doc time in largest population seen chest and epigastric pain and gains observed expedites access to the right care at the right time.
Diagnoses where the Teletriage patient experienced time savings, accounted for 33% of all ED visits within the date range of the pilot. Many of these diagnoses are among the most frequently occurring in the ED such as chest pain, nausea, abdominal pain, etc. Due to high patient volumes, our hypothesis theoretically substantiates increases in departmental throughput when applying the same, or similar, types of diagnoses.
Assistant Vice Presideant of Operations
Baptist Health South Florida
Leslee Gross, Assistant Vice President of Operations, has spent her entire career at Baptist Health South Florida. She holds a bachelor’s degree in nursing from Florida State University and a Masters degree from University of Saint Francis. Leslee’s career started in 1981 and her 30 plus years experience ranges from Staff Nurse, Charge Nurse, Assistant Nurse Manager of Baptist Hospital Emergency Department, and Director of BHSF Transfer Center to her current position as Assistant Vice President of Operations for BHSF. In 2009 Leslee was asked to start a Transfer Center for Baptist Health, which year to date has done over 250,000 transfers. As Assistant Vice President, Leslee oversees Telehealth, eICU Operations, The Transfer Center and Home Health for Baptist Health South Florida. In 2002, Leslee received Nurse of the Year award. In addition, she has spoken at the 2010 HIMSS Heath IT Conference; 2011 presented at ACHE Annual Conference; 2011 presented at American Hospital Association; 2013 started the Telestroke program for BHSF; 2014 testified at Appropriations Subcommittee on Health & Human Services. Leslee’s ePharmacy program was recognized for one of the most innovative programs of the year. In 2017 Leslee was appointed to Florida’s first Telehealth Advisory Council, this council will formulate recommendations in a report to be submitted to the Governor, the President of the Senate and the Speaker of the House.
Tuesday, April 25
10:45 AM – 11:04 AM