Teletriage

Under the Emergency Medicine Treatment and Labor Act (EMTALA), every patient who presents to an emergency department must receive a Medical Screening Exam (MSE). One approach to meet EMTALA MSE requirements has been the provider in triage (PIT) model. In most PIT models, an advanced practice provider (APP) will obtain an accurate history along with performing a focused physical examination to expedite care for the patient. With telemedicine quickly becoming a mainstream method of health care delivery, many institutions are considering a combination of a PIT model with telemedicine to improve patient throughput.

Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review

Background and objectives: Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care for both COVID-19 and non-COVID-19 patients. The purpose of this study is to systematically identify the facilitators and barriers experienced by outpatient health care organizations in an effort to maintain effective and efficient patient throughput during the pandemic. Materials and methods: This study systematically reviewed articles focused on initiatives taken by ambulatory care organizations to maintain optimal outpatient throughput levels while balancing pandemic precautions, published during 2020. Results: Among the 30 articles that met the inclusion criteria, three initiatives healthcare organizations have taken to maintain throughput were identified: the use (and enhanced use) of telehealth, protocol development, and health care provider training. The research team also identified three barriers to patient throughput: lack of telehealth, lack of resources, and overall lack of knowledge. Conclusions: To maintain patient throughput during the COVID-19 pandemic, healthcare organizations need to develop strategies such as the use of virtual consultation and follow-up, new guidelines to move patients along the care delivery value-chain, and ongoing training of providers. Additionally, the availability of required technology for telehealth, availability of resources, and adequate knowledge are vital for continuous patient throughput to ensure continuity of care during a pandemic.

Patient Throughput Times for Supplemental Breast Cancer Screening Exams

Background: To optimize screening abbreviated breast MRI (ABMR) operations, patient throughput times of ABMR were compared to breast ultrasound (US) and full protocol breast MRI (FPMR).Methods: Patient throughput times (mean ± standard error) and its subcomponents were analyzed for 95 ABMRs, 90 breast US exams, and 50 FPMRs. Total patient throughput was measured from registration time to the time of the last acquired image. Actual exam time was time difference between the first and last acquired images and pre-examination time was the calculated difference between throughput and actual exam times. Results: ABMR total patient throughput time was shorter than FPMR (55.7 ± 1.7 vs. 63.1 ± 2.0 min; difference, 7.4 min, 13%; p<0.001), but longer than breast US (39.1 ± 1.3 min; difference, 16.6 min, 30%; p<0.001). ABMR had shorter actual scan times than FPMR (13.4 ± 0.14 vs. 18.6 ± 0.25 min; p<0.001), but longer than US (9.6 ± 0.46 minutes; p<0.001). There was no difference in the pre-examination times between ABMR and FPMR (42.3 ± 1.7 vs. 44.6 ± 1.9 min; p = 0.357); pre-examination times were longer for both MR exam types compared to US (29.5 ± 1.3 minutes; p<0.001). Conclusion: ABMR patient throughput times are faster than FPMR, but these gains are limited as they have no impact on pre-examination activities which comprise the lengthiest components of the patient flow process. US patient flow currently remains faster than ABMR; however, comparable ABMR times could be achieved by further omitting certain sequences and optimizing pre-examination processes.