Having a licensed provider in triage can help to reduce leaving-without-being-seen rates to less than 1 percent. The provider can be either a physician or a physician extender; however, a registered nurse is still required to provide the triage of the patient.

The provider sees the patient immediately upon arrival, performs a limited history and physical, and then initiates the required care. After the initial observation by the provider, the patient is transferred to another emergency department (ED) physician for definitive treatment. With immediate triage, the hospital’s door-to-provider metric is dramatically improved and orders are written immediately. This allows patient care to begin while the provider can complete the medical screening exam on arrival.

Physical requirements for this model are minimal. It is imperative that patient privacy be maintained as a more thorough examination may take place than in a standard triage situation. The room requirements should include working space for the provider and nurse, as well as the patient and a family member. Consideration also should be given to space needed for a computer workstation, as well as basic examination and diagnostic equipment.

Having a provider in triage does not reduce the need for a properly staffed ED. Adequate staffing must be maintained throughout the ED for providers in triage to be effective. Inadequate staffing will result in delays in other key areas, including lab-order-to-result and imaging-order-to-result, which will merely shift the delay in patient care.

Marc Schlessinger, RRT, MBA, FACHE, is a senior associate in Plymouth Meeting, Pa.-based ECRI Institute’s Applied Solutions Group. His email is mschlessinger@ecri.org.