Effect of a rapid assessment program on total length of stay in a pediatric emergency department

Wait times and length of stay (LOS) measure efficiency of care in pediatric emergency departments (PEDs). Our hospital introduced a rapid assessment program (RAP) wherein patients will be seen by a physician within 29 minutes of arrival to the PED. Our primary objective was to evaluate the impact of this RAP on total LOS and compare it with the pre-RAP period. The secondary objective was to compare door-to-physician times and admission frequencies.

We conducted an observational study of randomly selected visits before (in 2004) and after (in 2005) RAP in a PED. Data were acquired retrospectively from charts. We compared total LOS (time from arrival at triage to discharge), boarding time (time from the decision to admit to transfer to inpatient bed), door-to-physician time (arrival at triage to first evaluation by physician), and admission frequencies.

Data from 990 visits (in 2004) and 1010 visits (in 2005) indicated similar age, sex, seasonal distribution, and weekday distribution. The total median LOS decreased by 37 minutes with RAP (103 [interquartile range {IQR}, 57-187] minutes in 2005 vs 140 [IQR, 78-234] minutes in 2004, P < 0.001) but only among lower triage categories. Median door-to-physician time decreased by 20 minutes with RAP (15 [IQR, 7-29] minutes in 2005 vs 35 [IQR, 18-72] minutes in 2004, P < 0.001) among lower triage categories. The LOS was reduced both in admitted and discharged patients with no difference in the boarding times or admission frequencies.

In our PED, a RAP reduced the total LOS of patients with lower acuity of illness.