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). OBJECTIVES: 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). METHOD: 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 821 (interquartile range [IQR] 602-1120) to 741 (IQR 522-1016) for all admitted patients (p < 0.001), and from 341 (IQR 205-558) to 335 (IQR 200-555) 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 (044; IQR 009-207 vs. 050; IQR 011-220 for admitted patients and 041; IQR 009-150 vs. 041; IQR 010-147 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.