title: Evaluation of a flexible acute admission unit: effects on transfers to other hospitals and patient throughput times.
abstract: BACKGROUND
  To prevent overcrowding of the emergency department, a flexible acute admission unit (FAAU) was created, consisting of 15 inpatient regular beds located in different departments. We expected the FAAU to result in fewer transfers to other hospitals and in a lower length of stay (LOS) of patients needing hospital admission.
  
  
  METHODS
  A before-and-after interventional study was performed in a level 1 trauma center in the Netherlands. Number of transfers and LOS of admitted ED patients in a 4-month period in 2008 (control period) and a 4-month period in 2009 (intervention period) were analyzed.
  
  
  RESULTS
  Of 1,619 regular admission patients, 768 were admitted in the control period and 851 in the intervention period. The number of transfers decreased from 80 (10.42%) to 54 (6.35%) (P = .0037). The mean ED LOS of both the non-admitted patients and the admitted patients needing special care significantly increased (105 minutes vs 117 minutes [P = .022] and 176 minutes vs 191 minutes [P < .001], respectively). However, the mean LOS of FAAU-admissible patients was unaltered (226 minutes vs 225 minutes, P = .865).
  
  
  CONCLUSIONS
  The FAAU reduced the number of transfers of admitted patients to other hospitals. The increase in LOS for special care patients and non-admitted patients was not observed for regular, FAAU-admissible patients. Flexible bed management might be useful in preventing overcrowding.
authors.affiliation: Emergency Department, Medical Center Haaglanden, The Hague, The Netherlands. c.van.der.linden@mchaaglanden.nl
authors.forename: Christien
authors.initials: C
authors.lastname: van der Linden
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.forename: Naomi
authors.initials: N
authors.lastname: van der Linden
authors.forename: Robert
authors.initials: R
authors.lastname: Lindeboom
mesh_terms: D000328:Adult; D017598:Efficiency, Organizational; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009426:Netherlands; D010343:Patient Admission; D010360:Patient Transfer / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000458:organization & administration*