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Effects of implementing a rapid admission policy in the ED.
Am J Emerg Med. 2007 Jun; 25(5):559-63.AJ

Abstract

OBJECTIVE

The purpose of this study is to determine the impact of a new rapid admission policy (RAP) on emergency department (ED) length of stay (EDLOS) and time spent on ambulance diversion (AD).

METHODS

The RAP, instituted in January 2005, allows attending emergency physicians to send stable patients, requiring admission to the general medicine service, directly to available inpatient beds. The RAP thereby eliminates 2 conventional preadmission practices: having admitting physicians evaluate the patient in the ED and requiring all diagnostic testing to be complete before admission. We compared patient characteristics, percentage of patients leaving without being seen, EDLOS for admitted patients, time on AD, and total adjusted facility charge for a 3-month period after the RAP implementation to the same period of the prior year.

RESULTS

There was a 1.1% increase in census with no difference in patient demographics, acuity, or disposition categories for the 2 periods. The EDLOS decreased on average by 10.1 minutes (95% confidence interval [CI], 3.3-17.0 minutes), resulting in an average of 4.2 hours of extra bed availability per day. Weekly minutes of AD decreased 169 minutes (95% CI, 29-310 minutes). There was also a 3.2% increase (95% CI, 3.1%-3.3%) in adjusted facility charge between these periods in 2005 compared with 2004.

CONCLUSIONS

The RAP resulted in a small decrease in the EDLOS, which likely decreased AD time. The resulting small increase in ED volume and higher acuity ambulance patients significantly improved ED revenue. Wider implementation of the policy and more uniform use among emergency physicians may further improve these measures.

Authors+Show Affiliations

Division of Emergency Medicine Stanford University, Palo Alto, CA 94304, USA. quinnj@stanford.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17543661

Citation

Quinn, James V., et al. "Effects of Implementing a Rapid Admission Policy in the ED." The American Journal of Emergency Medicine, vol. 25, no. 5, 2007, pp. 559-63.
Quinn JV, Mahadevan SV, Eggers G, et al. Effects of implementing a rapid admission policy in the ED. Am J Emerg Med. 2007;25(5):559-63.
Quinn, J. V., Mahadevan, S. V., Eggers, G., Ouyang, H., & Norris, R. (2007). Effects of implementing a rapid admission policy in the ED. The American Journal of Emergency Medicine, 25(5), 559-63.
Quinn JV, et al. Effects of Implementing a Rapid Admission Policy in the ED. Am J Emerg Med. 2007;25(5):559-63. PubMed PMID: 17543661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of implementing a rapid admission policy in the ED. AU - Quinn,James V, AU - Mahadevan,Swaminatha V, AU - Eggers,Garrett, AU - Ouyang,Helen, AU - Norris,Robert, PY - 2006/10/20/received PY - 2006/10/27/revised PY - 2006/11/02/accepted PY - 2007/6/5/pubmed PY - 2007/6/28/medline PY - 2007/6/5/entrez SP - 559 EP - 63 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 25 IS - 5 N2 - OBJECTIVE: The purpose of this study is to determine the impact of a new rapid admission policy (RAP) on emergency department (ED) length of stay (EDLOS) and time spent on ambulance diversion (AD). METHODS: The RAP, instituted in January 2005, allows attending emergency physicians to send stable patients, requiring admission to the general medicine service, directly to available inpatient beds. The RAP thereby eliminates 2 conventional preadmission practices: having admitting physicians evaluate the patient in the ED and requiring all diagnostic testing to be complete before admission. We compared patient characteristics, percentage of patients leaving without being seen, EDLOS for admitted patients, time on AD, and total adjusted facility charge for a 3-month period after the RAP implementation to the same period of the prior year. RESULTS: There was a 1.1% increase in census with no difference in patient demographics, acuity, or disposition categories for the 2 periods. The EDLOS decreased on average by 10.1 minutes (95% confidence interval [CI], 3.3-17.0 minutes), resulting in an average of 4.2 hours of extra bed availability per day. Weekly minutes of AD decreased 169 minutes (95% CI, 29-310 minutes). There was also a 3.2% increase (95% CI, 3.1%-3.3%) in adjusted facility charge between these periods in 2005 compared with 2004. CONCLUSIONS: The RAP resulted in a small decrease in the EDLOS, which likely decreased AD time. The resulting small increase in ED volume and higher acuity ambulance patients significantly improved ED revenue. Wider implementation of the policy and more uniform use among emergency physicians may further improve these measures. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/17543661/Effects_of_implementing_a_rapid_admission_policy_in_the_ED_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(06)00456-6 DB - PRIME DP - Unbound Medicine ER -