Related Experiment Video
Updated: Jun 12, 2025
Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Effectiveness of Direct Admission Compared to Admission Through the Emergency Department: A Stepped-Wedge
JoAnna K Leyenaar1,2, Stephanie C Acquilano2, Seneca D Freyleue2
1Dartmouth Health, Lebanon, New Hampshire.
Insights
Direct admission (DA) for children reduces emergency department (ED) visits. While initial assessment may be slightly slower, DA significantly speeds up therapeutic management and is safe for patients.
Area of Science:
- Pediatric Healthcare Management
- Hospital Operations
- Patient Flow Optimization
Background:
- Direct admission (DA) programs aim to reduce emergency department (ED) utilization by streamlining hospital admissions.
- Implementing DA can bypass the traditional ED admission process, potentially improving efficiency.
Purpose of the Study:
- To evaluate the impact of a voluntary direct admission (DA) program on the timeliness of care, family experience, and clinical outcomes in children.
- To compare outcomes for children admitted via DA versus the traditional ED route.
Main Methods:
- A stepped-wedge design was employed, randomizing 69 clinics to implement a DA program between February 2020 and April 2023.
- Outcomes for 2599 children under 18 with common medical diagnoses were compared between DA and ED admissions using adjusted regression analyses.
Main Results:
- Direct admission was associated with a modest increase in time to initial clinical assessment (3.1 minutes longer).
- However, direct admission significantly reduced time to initial therapeutic management by an average of 49.6 minutes.
- No significant differences were observed in time to diagnostic testing or rates of post-admission clinical deterioration.
Conclusions:
- Direct admission (DA) is a safe and acceptable alternative to emergency department (ED) admission for pediatric patients.
- DA offers a potential benefit by accelerating therapeutic management, despite a slight delay in initial assessment.
Objective:
Direct admission (DA) to hospital can reduce emergency department (ED) utilization by bypassing the ED during the admission process. We implemented a DA program across 3 health systems and compared timeliness of care, family experience of care, and post-admission clinical deterioration among children admitted via DA versus the ED after their clinic was randomized to begin the DA program.
Methods:
Using a stepped-wedge design, 69 primary and urgent care clinics were randomized to 1 of 4 time points to begin a voluntary DA program, February 1, 2020 to April 30, 2023. Outcomes in children <18 years admitted with 7 common medical diagnoses were compared using adjusted logistic or linear regression.
Results:
A total of 2599 children were admitted with eligible diagnoses during the study period , including 145 children admitted directly and 1852 admitted through EDs after program implementation at their clinic. Median age was 2.8 (interquartile range: 1.1-6.8) years, 994 (49.8%) were female, and 1324 (66.3%) were Medicaid-insured. Adjusted regression analyses showed that if each child was admitted via DA versus the ED, average time to initial clinical assessment was 3.1 minute (95% confidence interval: 1.7-4.5) slower, whereas time to initial therapeutic management was 49.6 minutes faster on average (95% confidence interval: 30.3.2-68.9). There were no significant differences in time to initial diagnostic testing or rates of post-admission clinical deterioration.
Conclusions:
Compared with ED admission, DA appears equally safe and acceptable to families, and may be associated with a significantly shorter time to initial therapeutic management with modestly longer time to initial clinical assessment.
More Related Videos
Related Concept Videos
01:13Randomized Experiments
Simple randomization
Simple...
01:12Hazard Ratio
For example, in a clinical trial...