Study objectives: Delays from registration to provider assessment have been shown to compromise patient care and to decrease patient satisfaction. To expedite this component of emergency department (ED) throughput we designed and implemented a team assignment system (TAS), in which patients who presented to our ED were assigned to a specific team. The team consisted of 1 emergency physician, 2 ED nurses, and usually 1 ED technician. That team was then responsible for the care for each assigned patient. We hypothesize that the TAS will expedite time from ED arrival to physician assessment and reduce the percentage of patients who left without being seen (LWBS) by a physician.

Methods: This before-and-after study was undertaken in a suburban community ED for 2 years surrounding the implementation of the TAS. Time is defined from patient registration or ambulance arrival to documented initiation of emergency physician evaluation. Percentage of patients treated within 1 hour and percentage of patients who waited more than 3 hours to be treated are reported from the subset of medical records with complete time documentation. Patients who LWBS are reported as percentages of total visits. Patient satisfaction scores from random mailings to a subset of patients were measured using 5-point Likert scales and assessed satisfaction with physician, staff courtesy, and coordination of care. We used inferential statistics to compare results and calculated 95% confidence intervals (CIs) for the intergroup differences.

Results: During the 12 months before and after TAS, the ED registered 38,716 and 39,301 patient visits, respectively. Complete time data were recorded on 34,152 (88.2%) and 32,537 (82.8%) of the medical records, respectively. Before TAS, 56.2% (19,186) of patients were treated within 1 hour, and after TAS, 64.0% (20,809) were treated within 1 hour. The difference between 1-hour groups is 7.8% (95% CI 7.6% to 8.0%; P<.0001). Before TAS, 17.8% (6,064) of patients waited more than 3 hours to be treated by an emergency physician. After TAS, 11.7% (3,792) waited more than 3 hours. The difference between 3-hour groups is 6.1% (95% CI 5.9% to 6.3%; P<.0001). Before TAS, 2.3% (906) of patients LWBS, and after TAS, 1.6% (617) of patients LWBS. The difference between LWBS groups is 0.8% (95% CI 0.7% to 0.9%; P<.0001). Patients who reported very good or excellent scores were as follows: for physician satisfaction, 67.2% before TAS (n=1567) and 69.8% after (n=1573) (difference 2.6%; 95% CI 1.9% to 3.6%; P=.113); for staff courtesy, 67.1% before TAS (n=1900) and 69.4% after (n=1908) (difference 2.3%; 95% CI 1.7% to 3.1%; P=.134); and for coordination of care, 62.5% before TAS (n=1897) and 66.2% after (n=1922) (difference 3.7%; 95% CI 2.9% to 4.7%; P=.015).

Conclusion: The implementation of TAS in our ED expedited the time from patient arrival to physician assessment and reduced the percentage of patients who LWBS. Patients' satisfaction of care showed a trend to improvement, which was significant with regard to their perception of overall coordination of care.