title: 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.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, University of California, Medical Center, San Diego, CA, USA. tcchan@ucsd.edu
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
authors.forename: James P
authors.initials: JP
authors.lastname: Killeen
authors.forename: Donna
authors.initials: D
authors.lastname: Kelly
authors.forename: David A
authors.initials: DA
authors.lastname: Guss
mesh_terms: 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