Introduction: Emergency department (ED) crowding is associated with detrimental effects on EDquality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding.Prior studies have evaluated attending physicians and advanced practice providers as TLPs, withlimited data evaluating resident physicians as TLPs. This study compares operational performanceoutcomes between resident and attending physicians as TLPs.

Methods: This retrospective cohort study compared aggregate operational performance at anurban, academic ED during pre- and post-TLP periods. The primary outcome was defined ascost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined asdifferences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of leftwithout being seen (LWBS), and proportion of “very good” overall patient satisfaction scores.

Results: Annual profit generated for physician-based collections through LWBS capture (afterdeducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss(ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable,with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time forresident TLPs was significantly lower (p<0.0001) than attending or historical control. Proportion of “verygood” patient satisfaction scores and LWBS was improved for both resident and attending TLPs overhistorical control. Overall median LOS was not significantly different.

Conclusion: Resident and attending TLPs improved DTP time, patient satisfaction, and LWBSrates. Both resident and attending TLPs are cost effective, with residents having a more favorablefinancial profile.

Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model.

Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT), social work or home health as determined by the GNL.

Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%), outpatient PT referrals (n=56, 12.2%) and social work consultation (n=162, 44%). 

Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

Introduction: Emergency department (ED) patients’ Internet search terms prior to arrival have notbeen well characterized. The objective of this analysis was to characterize the Internet search termspatients used prior to ED arrival and their relationship to final diagnoses.

Methods: We collected data via survey; participants listed Internet search terms used. Terms wereclassified into categories: symptom, specific diagnosis, treatment options, anatomy questions,processes of care/physicians, or “other.” We categorized each discharge diagnosis as either symptombasedor formal diagnosis. The relationship between the search term and final diagnosis was assignedto one of four categories of search/diagnosis combinations (symptom search/symptom diagnosis,symptom search/formal diagnosis, diagnosis search/symptom diagnosis, diagnosis search/formaldiagnosis), representing different “trajectories.”

Results: We approached 889 patients; 723 (81.3%) participated. Of these, 177 (24.5%) used theInternet prior to ED presentation; however, seven had incomplete data (N=170). Mean age was 47years (standard deviation 18.2); 58.6% were female and 65.7% white. We found that 61.7% searchedsymptoms and 40.6% searched a specific diagnosis. Most patients received discharge diagnoses ofequal specificity as their search terms (34% flat trajectory-symptoms and 34% flat trajectory-diagnosis).Ten percent searched for a diagnosis by name but received a symptom-based discharge diagnosiswith less specificity. In contrast, 22% searched for a symptom and received a detailed diagnosis.Among those who searched for a diagnosis by name (n=69) only 29% received the diagnosis that theyhad searched.

Conclusion: The majority of patients used symptoms as the basis of their pre-ED presentation Internetsearch. When patients did search for specific diagnoses, only a minority searched for the diagnosisthey eventually received. [West J Emerg Med. 2017;18(5)928-936.]