Does rapid assessment shorten the amount of time patients spend in the emergency department?
BACKGROUND
Overcrowding in the emergency department is a common phenomenon. This study assessed the impact of introducing a consultant-supported rapid assessment model, known as EDIT, and point of care testing upon the length of time patients spend in the emergency department.


METHODS
A prospective, observational cohort study was conducted in an emergency department in a district general hospital in the UK. The study consisted of two phases. Patients who attended the emergency department during phase 1 were assessed using a nurse-led triage model with blood samples being analysed in a centralized hospital laboratory. Phase 2 patients were assessed by a consultant-supported rapid assessment model with blood tests being analysed using point of care testing. The time from patient arrival in the emergency department to the time that care was complete and the patient was ready to move on to the next destination of care was recorded. These times from the two phases were compared using the Wilcoxon rank sum test.


RESULTS
A total of 11 213 patients attended the emergency department during the whole study period, of whom 4622 patients were eligible for the study. Phase 1 contained 3835 patients and phase 2 had 787 patients. The median time for patients to be declared ready to leave the emergency department in phase 1 was 129 minutes compared to 76 minutes for phase 2 (P=0.0025). This was a reduction in the median of 53 minutes or 41.1% (95% confidence interval 39.7-42.3%).


CONCLUSIONS
This study demonstrates that a consultant-supported rapid assessment model using point of care testing significantly shortens the time patients spend in the emergency department.
Consultant in Emergency Medicine, Calderdale & Huddersfield NHS Foundation Trust, Calderdale Royal Hospital, Halifax, West Yorkshire HX3 0PW.
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P
Jarvis
Tm
T
Davies
K
K
Mitchell
I
I
Taylor
M
M
Baker
D000328:Adult; D015331:Cohort Studies; D003441:Crowding; D019937:Diagnostic Techniques and Procedures / Q000592:standards*; D061345:Early Medical Intervention / Q000458:organization & administration; D004630:Emergencies / Q000523:psychology; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000379:methods / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D011446:Prospective Studies; D058996:Quality Improvement; D012017:Referral and Consultation / Q000458:organization & administration; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards; D006113:United Kingdom