title: Impact of an express admit unit on emergency department length of stay.
abstract: BACKGROUND
  Express admit units (EAUs) have been proposed as a way to expedite patient flow through the Emergency Department (ED).
  
  
  OBJECTIVE
  We sought to determine the effect of opening a five-bed EAU unit for temporary placement of admitted patients on our ED length of stay (LOS) and waiting room times (WT).
  
  
  METHODS
  This was a before-and-after interventional study of the 3-month period immediately before (pre-EAU) and after opening (post-EAU) of the EAU. We compared ED LOS and WT for patients admitted and discharged from the ED for both time periods, controlling for daily census and patient acuity.
  
  
  RESULTS
  During the post-EAU period, 386 patients (26.2% of total admits) were admitted through the EAU. Overall LOS decreased from 8:21 (interquartile range [IQR] 6:02-11:20) to 7:41 (IQR 5:22-10:16) for all admitted patients (p < 0.001), and from 3:41 (IQR 2:05-5:58) to 3:35 (IQR 2:00-5:55) for the discharged patients (p = 0.025). After controlling for census and acuity, the LOS decreased an average of 10% (95% confidence interval [CI] 6%-14%; p < 0.001) for admitted patients and 4% (95% CI 2%-7%; p = 0.001) for discharged patients. These changes represented a decreased LOS of about 50 and 9 min, respectively. There were no significant differences in WT (0:44; IQR 0:09-2:07 vs. 0:50; IQR 0:11-2:20 for admitted patients and 0:41; IQR 0:09-1:50 vs. 0:41; IQR 0:10-1:47 for discharged patients). However, after controlling for census and acuity, WT decreased 9% (95% CI 1%-16%; p = 0.022) for discharged patients, which represented a decrease of about 4 min.
  
  
  CONCLUSIONS
  With an EAU, there was a modest improvement in ED LOS despite an overall increase in daily ED volume.
authors.affiliation: Department of Emergency Medicine, University of California, San Diego, School of Medicine and Medical Center, San Diego, California 92103, USA.
authors.forename: Byron J
authors.initials: BJ
authors.lastname: Buckley
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
authors.forename: James P
authors.initials: JP
authors.lastname: Killeen
authors.forename: David A
authors.initials: DA
authors.lastname: Guss
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
mesh_terms: D000289:Admitting Department, Hospital / Q000458:organization & administration*; D002140:California; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006785:Hospitals, University / Q000458:organization & administration; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models