Data from this study were presented at the Canadian Association of Emergency Physicians annual scientific meeting, Montreal, Canada, May 29–June 2, 2010, and received the Grant Innes Canadian Association of Emergency Physicians Research Award.
Original Research Contribution
The Role of Triage Nurse Ordering on Mitigating Overcrowding in Emergency Departments: A Systematic Review
Article first published online: 21 JUN 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Special Issue: Proceedings of the 2011 AEM Consenus Conference: Interventions to Assure Quality in the Crowded Emergency Department Guest Editors: James R. Miner, MD Manish N. Shah, MD, MPH
Volume 18, Issue 12, pages 1349–1357, December 2011
How to Cite
Rowe, B. H., Villa-Roel, C., Guo, X., Bullard, M. J., Ospina, M., Vandermeer, B., Innes, G., Schull, M. J. and Holroyd, B. R. (2011), The Role of Triage Nurse Ordering on Mitigating Overcrowding in Emergency Departments: A Systematic Review. Academic Emergency Medicine, 18: 1349–1357. doi: 10.1111/j.1553-2712.2011.01081.x
This study was funded by a grant from the Canadian Institutes for Health Research (CIHR; 200810KRS). Dr. Schull is supported by the CIHR as an Applied Chair in Health Services and Policy Research (Ottawa, ON). Dr. Villa-Roel is supported by CIHR in partnership with the Knowledge Translation branch. Dr. Rowe is supported by the 21st Century Canada Research Chairs program through the Canadian Institutes of Health Research (CIHR) by the Government of Canada (Ottawa, ON).
The authors have no relevant potential conflicts of interest to disclose.
Supervising Editor: Christopher Carpenter, MD.
- Issue published online: 13 DEC 2011
- Article first published online: 21 JUN 2011
- Received December 15, 2010; revision received February 14, 2011; accepted February 17, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:1349–1357 © 2011 by the Society for Academic Emergency Medicine
Objectives: The objective was to examine the effectiveness of triage nurse ordering (TNO) on mitigating the effect of emergency department (ED) overcrowding.
Methods: Electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, SCOPUS, Web of Science, HealthSTAR, Dissertation Abstracts, ABI/INFORM Global), controlled trial registry websites, conference proceedings, study references, experts in the field, and correspondence with authors were used to identify potentially relevant studies. Interventional studies in which TNO was used to influence ED overcrowding metrics (length of stay [LOS] and physician initial assessment [PIA]) were included in the review. Two reviewers independently assessed study eligibility and methodologic quality. Mean differences were calculated and reported with corresponding 95% confidence intervals (CIs).
Results: From more than 14,000 potentially relevant studies, 14 were included in the systematic review. Most were single-center ED studies; the overall quality was rated as weak, due to methodologic deficiencies and variable outcome reporting. TNO was associated with a 37-minute mean reduction (95% CI = −44.10 to −30.30 minutes) in the overall ED LOS in one randomized clinical trial (RCT); a 51-minute mean reduction (95% CI = −56.3 to −45.5 minutes) was observed in non-RCTs. When applied to injured subjects with suspected fractures, TNO interventions reduced ED LOS by 20 minutes (95% CI = −37.5 to −1.9 minutes) in three RCTs and by 18 minutes (95% CI = −23.2 to −13.2) in two non-RCTs. No significant reduction in PIA was observed in two RCTs.
Conclusions: Overall, TNO appears to be an effective intervention to reduce ED LOS, especially in injury and/or suspected fracture cases. The available evidence is limited by small numbers of studies, weak methodologic quality, and incomplete reporting. Future studies should focus on a better description of the contextual factors surrounding these interventions and exploring the impact of TNO on other indicators of productivity and satisfaction with health care delivery.