Does initiating care in alternate care sites decrease time to disposition in the emergency department?

Area of Science:

• Emergency Medicine
• Healthcare Operations
• Patient Flow Management

Background:

• Alternate Care Sites (ACS) were established during the COVID-19 pandemic to manage emergency department (ED) overflow.
• Many ACS remain operational post-pandemic due to persistent ED wait times.
• Providers are increasingly initiating patient care in ACS to address prolonged ED wait times.

Purpose of the Study:

• To evaluate the impact of initiating patient care in ACS on door-to-disposition (DTD) time.
• To determine if early patient assessment in ACS reduces overall ED length of stay.

Main Methods:

• Retrospective analysis of 61,869 patient encounters at an academic medical center ED.
• Comparison of pre-ACS (n=38,625) and post-ACS (n=23,244) cohorts, excluding Emergency Severity Index (ESI) 1 patients.
• Door-to-disposition time calculated from ED entry to disposition decision, analyzed using regression analysis.

Main Results:

• Median DTD significantly increased for ESI 2 (40.9 min) and ESI 3 (18.8 min) patients seen initially in ACS.
• A 29-min decrease in median DTD was observed for ESI 5 patients seen in ACS, though not statistically significant (p=0.09).
• The majority of encounters (56.1%) were ESI 3 patients.

Conclusions:

• Early initiation of patient care in ACS did not reduce DTD for ED patients.
• The advantages of early care initiation in ACS may not directly translate to decreased DTD.
• Potential benefits of ACS may lie in other areas of patient care or ED throughput optimization.