73 Reducing Door-to-Provider Time By Creating a Triage Liaison Physician Line in an Urban Emergency Department During the COVID-19 Pandemic

Kindschuh, M. W.; Radeos, M. S.; Lee, B.; Jeong, J.; Yap, W. M.; Ostrovsky, A.; Calandro, D.; Juliano, P.

Background: The COVID-19 pandemic has resulted in huge numbers of serious morbidity and mortality that overwhelmed emergency departments (EDs) worldwide. Here in New York City, we experienced a case fatality rate of 12.2% between March 21, 2020 and May 20, 2020. Once the initial wave subsided, we noted that our ED census was unusually low. In order to avoid cutting staff in response to that ominous trend, we explored the reassignment of staff in order to improve our ED operations. We chose the model of triage liaison physician (TLP), an efficient method of improving patient throughput. This would allow us to maintain staff that might otherwise by furloughed or lost permanently. Study Objectives: We present the results of our departmental performance improvement (PI) initiative, focusing on the metric of door-to-provider time (DPT). Methods: We obtained IRB approval to analyze data from our ED dashboard. We focused on data from ten weeks before the initiation of the TLP to 24 weeks thereafter. We restricted the data to include only patients who arrived between 10:00 AM and 2:00 AM, as those were the hours where a TLP was on duty. We measured median DTP times and created run charts and control charts to demonstrate how the TPL affected the DTP metric. The control chart was our way of determining if any improvement was a process that could be sustainable. Results: For the ten-week period prior to the initiation of the TLP, median DPT was 18 minutes. After initiation of the TLP, our median DTP was 7 minutes. This apparent improvement was supported by a run chart that showed the dramatic decrease, and by a control chart that showed the stability of the new TLP process. Conclusion: Our data suggest that reassigning an attending physician to the role of TPL allows an ED to retain valuable attending physicians while also improving patient safety metrics such as DTP. Future research should focus on other potential benefits of the TLP, such as revenue generated by reducing patients who leave without being seen, earlier detection of sepsis and stroke, and reduced dwell times in the ED. [Formula presented]