title: Rapid medical assessment: improving pediatric emergency department time to provider, length of stay, and left without being seen rates.
abstract: OBJECTIVE
  This article aimed to study the impact of a rapid medical assessment (RMA) program on patient flow and left without being seen (LWBS) rates in a pediatric emergency department (ED). RMA is designed to evaluate and discharge uncomplicated patients quickly or initiate diagnostic workup and treatment before the patient is placed in an ED bed.
  
  
  METHODS
  Rapid medical assessment was initiated January 1, 2008 with an assigned midlevel provider. We compared 6 months of data from January 1 to June 30, 2007 (pre-RMA), to January 1 to June 30, 2008 (post-RMA). Data studied were obtained from a tracking system and include the time to provider, ED length of stay, and the LWBS rate. t Test was used to compare results, and χ test was used to compare LWBS rates.
  
  
  RESULTS
  During the study period, there were 28,360 patients seen in 2007 and 32,053 in 2008. Time to provider mean time was 80 minutes (median = 57) in 2007 and 53 minutes (median = 39) in 2008, with a difference of 27 minutes (95% confidence interval, 25-28 minutes). Mean length of stay in 2007 was 239 minutes (median = 220) compared to 181 minutes (median = 162) in 2008, with a difference of 58 minutes (95% confidence interval, 56-60 minutes). The LWBS rate decreased from 9% in 2007 to 3% in 2008 (χ P < 0.01).
  
  
  CONCLUSIONS
  Rapid medical assessment is an effective way to improve patient flow and reduce the LWBS rate. A decrease in the LWBS rate allows the ED to provide health care to these potentially high-risk patients.
authors.affiliation: Department of Emergency Medicine, University of California, Davis, Sacramento, CA 95817, USA. vwtsai@gmail.com
authors.forename: Virginia W
authors.initials: VW
authors.lastname: Tsai
authors.forename: Ghazala Q
authors.initials: GQ
authors.lastname: Sharieff
authors.forename: John T
authors.initials: JT
authors.lastname: Kanegaye
authors.forename: Lesley Ann
authors.initials: LA
authors.lastname: Carlson
authors.forename: Jim
authors.initials: J
authors.lastname: Harley
mesh_terms: D002140:California; D002648:Child; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care / Q000379:methods*; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014218:Triage; D014850:Waiting Lists