EFFECT OF EM PHYSICIAN-LED TRIAGE ON ED LENGTH OF STAY, A CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.71000/m0cf3c52Keywords:
Emergency Service, Hospital, Emergency Treatment, Length of Stay, Physician's Role, Patient Flow, Triage, WorkloadAbstract
Background: Emergency Department (ED) crowding remains a major global healthcare challenge, linked with increased adverse events, delays in care, and higher rates of patients leaving without being seen (LWBS). Efficient triage plays a crucial role in optimizing patient flow, reducing bottlenecks, and enhancing overall ED performance. In developing emergency care systems, the seniority of the triage physician may influence key operational metrics such as ED length of stay (LoS).
Objective: To determine the effect of emergency medicine (EM) physician seniority during triage on ED LoS and to explore its relationship with triage acuity levels.
Methods: A prospective, cross-sectional, comparative study was conducted over 12 months in the ED of a high-volume tertiary care hospital. A total of 150 patients were screened, and 138 adult patients met inclusion criteria. Data were collected from structured proformas and electronic medical records, including age, gender, triage category, triaging physician seniority (senior post-IMM vs. junior resident), and LoS timestamps from registration to disposition. Descriptive statistics were calculated using IBM SPSS version 26. The association between physician seniority and LoS was analyzed using the Chi-square test, with significance set at p < 0.05.
Results: The overall mean ED LoS was 284 ± 112 minutes (median 265). Patients triaged by senior EM residents had a substantially lower mean LoS of 238 ± 98 minutes, compared with 307 ± 115 minutes among those triaged by junior residents, demonstrating a 69-minute reduction. A statistically significant association was found between senior-led triage and a LoS below the median (χ² = 10.24, p = 0.001). LoS increased progressively across triage categories, from 185 minutes in Category I to 321 minutes in Category IV, confirming consistent prioritization for higher-acuity patients.
Conclusion: Triage performed by senior EM residents is associated with a meaningful reduction in ED LoS, supporting the integration of senior physicians into frontline triage to enhance patient flow and operational efficiency in resource-limited settings.
References
Brink A, Alsma J, van Attekum LA, Bramer WM, Zietse R, Lingsma H, Schuit SC. Predicting inhospital admission at the emergency department: a systematic review. Emergency medicine journal. 2022 Mar 1;39(3):191-8.
Javidan AP, Hansen K, Higginson I, Jones P, Lang E. The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary. Emergency Medicine Journal. 2021 Mar 1;38(3):245-6.
Lindner G, Woitok BK. Emergency department overcrowding: Analysis and strategies to manage an international phenomenon. Wiener Klinische Wochenschrift. 2021 Mar;133(5):229-33.
Sartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM, Cremonesi P, Canale F, Cristina ML. Overcrowding in emergency department: causes, consequences, and solutions—a narrative review. InHealthcare 2022 Aug 25 (Vol. 10, No. 9, p. 1625). MDPI.
Smalley CM, Meldon SW, Simon EL, Muir MR, Delgado F, Fertel BS. Emergency department patients who leave before treatment is complete. Western Journal of Emergency Medicine. 2021 Feb 26;22(2):148.
Kenny JF, Chang BC, Hemmert KC. Factors affecting emergency department crowding. Emergency medicine clinics. 2020 Aug 1;38(3):573-87.
Zeleke TA, Nora WT, Denberu MT, Adal O, Demisse LB. Length of stay and associated factors among pediatric patients in the pediatric emergency unit of the Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. BMC Emergency Medicine. 2024 Sep 19;24(1):170.
Adhikari B, Shrestha L, Bajracharya M, Aryal N, Rajbhandari A, Maharjan RK, Das SK, Sapkota J, Tetteh KK, Das D. Triage practices for emergency care delivery: a qualitative study among febrile patients and healthcare workers in a tertiary care hospital in Nepal. BMC Health Services Research. 2024 Feb 8;24(1):180.
Bano, H., Sohail, A., Pervez, T., & Kasi, H. (2025). Assessing Awareness and Attitudes of Doctors, Nurses and Healthcare Administrators towards the Role of Advanced Nurse Practitioners in the Emergency Department: A Cross-Sectional Study. Indus Journal of Bioscience Research, 3(2), 731-738.
Heslin SM, Schwaner R, Viccellio P, King C, Rowe A, Thode H, Singer AJ. A physician-nurse team adjacent to triage shortens length of stay and left-without-being-seen rates. Clinical and Experimental Emergency Medicine. 2024 Sep 6;12(1):26.
Shih HI, Huang YT, Hsieh CC, Sung TC. A rapid clinic-based service for an emergency department of a tertiary teaching hospital during a dengue outbreak. Medicine (Baltimore). 2021;100(14):e25311.
Grotta JC, Yamal JM, Parker SA, Rajan SS, Gonzales NR, Jones WJ, et al. Prospective, Multicenter, Controlled Trial of Mobile Stroke Units. N Engl J Med. 2021;385(11):971-81.
Youssef E, Benabbas R, Choe B, Doukas D, Taitt HA, Verma R, et al. Interventions to improve emergency department throughput and care delivery indicators: A systematic review and meta-analysis. Acad Emerg Med. 2024;31(8):789-804.
Uffen JW, Oosterheert JJ, Schweitzer VA, Thursky K, Kaasjager HAH, Ekkelenkamp MB. Interventions for rapid recognition and treatment of sepsis in the emergency department: a narrative review. Clin Microbiol Infect. 2021;27(2):192-203.
Roos J, Helm S, Touet A, Cucchi D, Welle K, Weinhold L, et al. Insights into orthopedic and trauma emergency care and current challenges in Germany. Eur J Trauma Emerg Surg. 2025;51(1):180.
Sax DR, Warton EM, Mark DG, Reed ME. Emergency Department Triage Accuracy and Delays in Care for High-Risk Conditions. JAMA Netw Open. 2025;8(5):e258498.
Freund Y, Cancella de Abreu M, Lebal S, Rousseau A, Lafon T, Yordanov Y, et al. Effect of the 1-h bundle on mortality in patients with suspected sepsis in the emergency department: a stepped wedge cluster randomized clinical trial. Intensive Care Med. 2024;50(7):1086-95.
Leon-Justel A, Jimenez-Barragan M, Navarro-Bustos C, Martin-Perez S, Garrido-Castilla JM, Morales-Barroso IM, et al. Development and validation of an advanced data analytics model to support strategic point-of-care testing utilization decisions in the emergency department. J Med Econ. 2025;28(1):871-84.
Tudorache R, Kossorotoff M, Kerleroux B, Denier C, Naggara O, Boulouis G. Determinants of Timely Access to Recanalization Treatments and Outcomes in Pediatric Ischemic Stroke. Stroke. 2024;55(11):2716-9.
Jing J, Xie X, Leng X, Wang D, Wang Y. Chinese Stroke Association guidelines on emergency stroke unit. Stroke Vasc Neurol. 2024;9(6):741-5.
Ebinger M, Siegerink B, Kunz A, Wendt M, Weber JE, Schwabauer E, et al. Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Patients With Acute Ischemic Stroke in Berlin. Jama. 2021;325(5):454-66.
Chiang D, Ade JM, Liu XW, Bellolio F, Lohse CM, Sandefur BJ, et al. Assessment of ED triage of anaphylaxis patients based on the Emergency Severity Index. Am J Emerg Med. 2021;46:449-55.
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Copyright (c) 2025 Muhammad Ashfaq, Tamkeen Pervez, Amer Iqbal, Anees Ur Rehman, Annas Mehboob, Umair Ali (Author)
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