SHM Converge Scientific Abstract ePoster Gallery-Medicine Triage Reimagined: Improving Care in a Cost-Effective Manner

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The document describes the “Medicine Triage Admitting Doctor” (MTAD), a hospitalist-led pilot designed to improve emergency department (ED) throughput and reduce unnecessary admissions to Department of Medicine (DOM) inpatient services. The intervention was created in response to well-documented harms of ED crowding, including longer lengths of stay, higher inpatient mortality, and increased readmission risk.<br /><br />During weekdays from 10 AM to 8 PM, one MTAD reviewed all ED requests for admission to 12 medicine and subspecialty services, as well as downgrades from the medical ICU. The MTAD collaborated closely with emergency medicine, capacity management nurses, and inpatient teams to determine the safest and most efficient disposition for each patient. Unlike earlier triage models, this role not only expedited admissions but also redirected some patients to observation status or outpatient care when appropriate.<br /><br />In the first four months, the MTAD reviewed 909 patients and intervened on 302 of them, affecting disposition in 33.2% of cases. Reported outcomes included 55 downgrades to the ED Observation Unit, 9 short-stay admission/discharge cases, and 64 avoided admissions. The pilot estimated a revenue opportunity of $365,000 from avoided admissions and projected annual cost savings of $960,000, compared with an implementation cost of $569,000 for 2 FTE benefits.<br /><br />The pilot suggests that the MTAD model can improve patient flow, support safer admissions, and produce a favorable return on investment. Next steps include more detailed analysis of flow metrics such as time to team assignment, time from ED to medicine handoff, and time from assignment to inpatient floor arrival, along with qualitative evaluation of its impact on staff perception and interdepartmental culture.

Asset Subtitle

Joyce Kim

Meta Tag

Author List Amanda Whartenby, Joyce Kim, Keith Hemmert, Michael J. Neuss, Sara VanCalcar

Category Innovations

Concept Medicine Triage Admitting Doctor

Concept ED Throughput

Concept Patient Disposition

Concept Department of Medicine

Concept Disposition Change

Distinguished Non-Finalist

Presenter Organization University of Pennsylvania

Presenting Author Joyce Kim

Track Quality Improvement

Keywords

medicine triage admitting doctor

MTAD

emergency department throughput

hospital admissions

hospitalist-led pilot

department of medicine

ED crowding

observation status

avoided admissions

cost savings

Medicine Triage Admitting Doctor

ED Throughput

Patient Disposition

Department of Medicine

Disposition Change