Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen.
OBJECTIVE
Patients who leave before being seen by a physician represent a significant problem for many emergency departments (EDs). We sought to determine the effect of a new ED rapid entry and accelerated care at triage (REACT) process on the frequency of patients who leave before being seen.


METHODS
We conducted a before-after intervention design to study the effect of REACT for ambulatory patients presenting to our urban academic center ED with a census of approximately 37,000. This process redesign included patient identification tracking, integrated computer interfaces to eliminate up-front registration tasks, immediate placement of patients in open ED beds, and physician-directed ancillary testing and care at triage when no ED beds were available. Outcome measures included the average monthly rate of patients who left before being seen during the 6 months before (pre-REACT) and 6 to 12 months after (post-REACT) its initiation. Other measures included average of mean monthly rates of wait times, ED length of stay, ED census, and admissions.


RESULTS
There was a significant decrease in leave before being seen frequency from the pre-REACT to post-REACT periods (3.2% absolute decrease [95% confidence interval (CI) 1.9% to 4.6%]), despite an overall increase in ED census. Average mean monthly patient wait times decreased by 24 minutes [95% CI 10 to 38 minutes] after the initiation of REACT, as did overall ED length of stay by 31 minutes [95% CI 6 to 57 minutes].


CONCLUSIONS
The initiation of a rapid entry and accelerated care process significantly decreased patient leave before being seen rates, average wait times and length of stay, despite an overall increase in patient census.
Chan
Theodore C
TC
Department of Emergency Medicine, University of California, Medical Center, San Diego, CA, USA. tcchan@ucsd.edu
Killeen
James P
JP
Kelly
Donna
D
Guss
David A
DA
D000553:Ambulatory Care / Q000458:organization & administration / Q000706:statistics & numerical data; D002140:California; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration* / Q000706:statistics & numerical data; D014850:Waiting Lists