The Impact of a Flexible Care Area on Throughput Measures in an Academic Emergency Department

Crowding in emergency departments is a multifaceted problem. We hypothesized that implementing an on-call "Flexible Care Area" (FCA), utilizing multiple front-end throughput solutions, would reduce ED length of stay (LOS).

This retrospective study evaluates the impact of an FCA on ED throughput at one hospital over a 2-year period (2011-2012). The average arrival-to-room time, arrival-to-physician time, LOS, number of inpatient admissions, and number of discharges during FCA hours were collected, and days with and without FCA functionality were compared.

The FCA was open 165 days in 2011 and 252 days in 2012. The mean daily ED census, as well as the number of ED visits and inpatient admissions during FCA hours, were higher on days with FCA functionality than on days without FCA functionality. Total ED LOS was shorter for Emergency Severity Index (ESI) level 3 patients on days with FCA than on days without it in 2011, but this finding was not repeated in 2012. ESI level 4 patients had shorter LOS on FCA days in both years. The arrival-to-room and arrival-to-physician times showed variable improvement for ESI level 3 and 4 patients over the study period. No statistically significant difference for these measures was found when evaluating ESI levels 2 and 5.

Implementing upfront throughput solutions through use of the FCA correlated with reduced ED LOS for all ESI level 3 and 4 patients, not just those who were seen in the FCA.