WASHINGTON -- Patients facilitated into a pilot emergency department program meant to speed triage received care nearly twice as fast as other patients who presented at the ED, researchers said here.
University of Chicago Medicine researchers created and evaluated the "Dr. Admit" initiative, finding that its admitted patients received care an average of 192 minutes after arrival, versus 329 minutes for other patients. The median admission time for Dr. Admit patients was also lower (165 versus 271 minutes), said Tom Spiegel, MD, medical director at the hospital's emergency department, at the .
"We got the appropriate care to the most needy patients," Spiegel said. Pointing to a graph, he added: "Most [Dr. Admit] patients were admitted much sooner on the front end."
Under Dr. Admit, medical staff handling ED triage answer a series of questions: Does the patient look sick? Will the patient likely be admitted? If the answers are a "clear yes," according to Spiegel, Dr. Admit is activated. If staff are unsure, the patient is immediately referred to an available physician or resident/attending provider for potential admission into Dr. Admit. Other patients are triaged into a waiting room.
The program fosters collaboration between ED providers and nurses, and with providers in other departments (radiology, consults and labs), Spiegel reported. It breaks down medical hierarchies; when nurses page ED physicians with a Dr. Admit patient, for example, the physicians are required to respond to the page. "The nurses loved it," he said.
Researchers launched Dr. Admit in November 2015, conducting the study in their urban academic center over the next year. Their central research question: if a competent emergency physician can tell within minutes who needs rapid treatment, why does it often take hours to get patients admitted?
Dr. Admit's ultimate "goal is having results that will help facilitate admission to an inpatient service within one hour of activating the process," according to Spiegel's .
The study's primary outcome was admission time, defined as the time between patients' arrival and the time their admission order was entered into the EMR. Among the 11,820 patients admitted to the hospital who were triaged as either Level 1 or 2 on the (ESI) over the year measured, 1,911 were assigned to Dr. Admit. (The ESI is a five-point scale, with "1" the most urgent.)
Spiegel's Chicago has since "continued and expanded" Dr. Admit, he said, adding that he "absolutely" recommends other EDs adopt it: "It helps patients and staff, and it fosters teamwork."
Primary Source
American College of Emergency Physicians
Speigel T "Dr. Admit: Reducing admission decision time for clinically ill patients" ACEP 2017; Abstract 51.