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

Alyssa Mangino1, Lakshman Balaji1, Bryan Stenson1

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Journal of the American College of Emergency Physicians Open
|August 6, 2024
PubMed
Summary
This summary is machine-generated.

Initiating patient care in alternate care sites (ACS) did not decrease door-to-disposition time for emergency department (ED) patients. Benefits of early care initiation may be found in other aspects of patient care and ED throughput.

Keywords:
ED boardingED crowdingalternate care sitesdoor‐to‐disposition timedoor‐to‐doctoremergency severity indexwaiting room

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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.