1. Kranz, Haley PA-S

Article Content

Dear Editor,

I have read the article in the May/June 2017 edition by Brosinski, Riddell, and Valdez published in Clinical Nurse Specialist, 31(3), 145-148. I want to commend the authors for this article and make some contributions.


Although the article established that refining and increasing the frequency of triage training would decrease the amount of patients who are incorrectly triaged, there are other ways to improve triage that have proven to be effective. One route that is being explored is the use of triage liaison providers (TLPs). A TLP is a physician or advanced level provider who works in triage and begins patient assessment before the patient is taken back into an emergency department (ED) room.1 The use of TLPs accomplishes the same objective as triage training, while also improving the length of stay in the ED, door-to-provider time, the proportion of patients who left without being seen, and the patients' overall satisfaction.2 According to Nestler et al,1 the duties of the TLP include performing an assessment while asking a limited number of questions and/or completing a brief physical examination. If needed, the TLP would then order any blood tests or radiographic studies.1 While the TLP is completing his/her responsibilities, the nurse controls the flow of triage and also helps with rapid patient assessments.1


One limitation that has been previously discussed about TLPs is the cost of a provider working in triage compared with a nurse.2 However, according to Weston et al,2 their study concluded that both resident and attending TLPs were cost-effective, with the resident being more cost-effective. In Brosinski et al's article, there was no discussion of costs involved with increasing the amount of triage training. Considering that there would need to be a lecturer and probably funds to compensate the nurses for their time, increasing the training may not be the most cost-effective option. The application of TLPs is a great option for improving triage in facilities that have multiple providers available. Although Brosinski et al3 addressed the amount of nurses who were participants in the study, there was no discussion on how many providers worked in the ED.


The article concludes that increasing the frequency of refresher training, posting monthly triage accuracy rates, and completing monthly chart reviews addressing the Emergency Severity Index discrepancies have been shown to improve triage categorization, leading to a decreased risk of poor patient outcomes.3 There is imperative information missing from the article to compare its effectiveness with other methods to improve triage, such as costs involved and the amount of providers who work in the ED. The use of TLPs could have demonstrated to be a better option for improving the triage in this ED if we were given this information.




Haley Kranz, PA-S


Fort Myers, Florida




1. Nestler DM, Fratzke AR, Church CJ, et al. Effect of a physician assistant as triage liaison provider on patient throughput in an academic emergency department. Acad Emerg Med. 2012;19(11):1235-1241. [Context Link]


2. Weston V, Jain SK, Gottlieb M, et al. Effectiveness of resident physicians as triage liaison providers in an academic emergency department. West J Emerg Med. 2017;18(4):577-584. [Context Link]


3. Brosinski CM, Riddell AJ, Valdez S. Improving triage accuracy: a staff development approach. Clin Nurs Spec. 2017;31(3):145-148. [Context Link]