Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department

J Emerg Med. 2012 Mar;42(3):322-8. doi: 10.1016/j.jemermed.2010.04.022. Epub 2010 Jun 15.


Background: Emergency Department (ED) crowding is well recognized, and multiple studies have demonstrated its negative effect on patient care.

Study objectives: This study aimed to assess the effect of an intervention, Supplemented Triage and Rapid Treatment (START), on standard ED performance measures. The START program complemented standard ED triage with a team of clinicians who initiated the diagnostic work-up and selectively accelerated disposition in a subset of patients.

Methods: This retrospective before-after study compared performance measures over two 3-month periods (September-November 2007 and 2008) in an urban, academic tertiary care ED. Data from an electronic patient tracking system were queried over 12,936 patients pre-intervention, and 14,220 patients post-intervention. Primary outcomes included: 1) overall length of stay (LOS), 2) LOS for discharged and admitted patients, and 3) the percentage of patients who left without complete assessment (LWCA).

Results: In the post-intervention period, patient volume increased 9% and boarder hours decreased by 1.3%. Median overall ED LOS decreased by 29 min (8%, 361 min pre-intervention, 332 min post-intervention; p < 0.001). Median LOS for discharged patients decreased by 23 min (7%, 318 min pre-intervention, 295 min post-intervention; p < 0.001), and by 31 min (7%, 431 min pre-intervention, 400 min post-intervention) for admitted patients. LWCA was decreased by 1.7% (4.1% pre-intervention, 2.4% post-intervention; p < 0.001).

Conclusions: In this study, a comprehensive screening and clinical care program was associated with a significant decrease in overall ED LOS, LOS for discharged and admitted patients, and rate of LWCA, despite an increase in ED patient volume.

MeSH terms

  • Adult
  • Aged
  • Emergency Service, Hospital / organization & administration*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospitals, Teaching / statistics & numerical data
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Admission / statistics & numerical data
  • Process Assessment, Health Care
  • Retrospective Studies
  • Time Factors
  • Treatment Refusal / statistics & numerical data
  • Triage / organization & administration*
  • Triage / statistics & numerical data