Evaluation of Emergency Department Throat Pain Protocol to Reduce Left Without Being Seen, Length of Stay, and Antibiotic Prescribing

Background: Increasing numbers of people are seeking unscheduled, medical care in United States’ emergency departments (ED) which contributes to crowding, delayed throughput and increased patient’s length of stay. Implementation of advanced treatment protocols such as a throat pain protocol initiates early diagnostic testing, optimizes patient throughput strategies, and promotes adherence to clinic practice guidelines for an additional segment of patients.
Aim: To evaluate the effect of an advanced treatment protocol (ATP) for throat pain.
Methods: The electronic medical records for 117 patients presenting with throat pain to the ED of a community hospital were reviewed and separated into three groups: no testing, medical provider initiated testing, or nurse initiated testing. Main outcome variables were number of patients that leave without being seen (LWOBS), patient’s length of stay, and antibiotic prescribing. Donabedian’s conceptual model for examining health services and evaluating quality of care was utilized to implement this evidence-based project (Donabedian, 1997).
Results: No patients LWOBS from the nurse initiated ATP group or no testing group compared to 3% from the medical provider initiated group. By eliminating these LWOBS patients, there is a potential cost savings of $3,420 over a 12 month period. The overall length of stay (median) was four minutes shorter in the nurse initiated ATP group than the other two groups evaluated. Antibiotic prescriptions were given for 48% of patients in the nurse initiated group compared to 52% in the medical provider group, and 70% in the no testing group.
Conclusion: While this department has only partially implemented an ATP for throat pain, it highlights the benefits to reduce LWOBS, patient’s length of stay, and antibiotic prescribing.