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The Effect of a Rapid Assessment Team on Pediatric Emergency Medicine Department Operations and Throughput
Richard Ramirez1, Michelle Blumstein1, David Lowe1
1Nicklaus Children's Hospital.
Objectives:
Length of stay (LOS) and left without being seen (LWBS) rates are key measures of emergency department (ED) throughput. Few studies in the pediatric ED setting exist looking at the effect of rapid assessment team models on department operations/throughput. At our institution, a rapid assessment team was implemented to respond to patients who indicated a desire to leave before being evaluated, expedite assessment/treatment of lower-acuity cases that could be discharged directly, and initiate workups for patients experiencing excessive door-to-doctor times. We hypothesized that implementation of this team would be associated with decreased LOS, LWBS rates, and door-to-provider times in a pediatric ED.
Methods:
We conducted a single-institution retrospective chart study to determine whether implementation of a rapid assessment team improved standard efficiency metrics (LWBS, LOS, door-to-provider time) within our pediatric ED. Data from a 4-year period (prerapid and postrapid assessment team implementation) were analyzed. Bivariate analyses (independent t test, Mann-Whitney U test, and χ 2 test) were used to assess the association between baseline characteristics and primary outcomes. Multivariable logistic regression for the LWBS rate and linear regression for LOS examined the association between different time periods and outcomes while controlling for confounders.
Results:
In total, 348,483 valid cases were analyzed. After implementation, the LWBS rate decreased from 0.7% to 0.5% (OR: 0.79, 95% CI: 0.72-0.87; P <0.001). Mean LOS decreased by 15.7 minutes (95% CI: 14.8-16.7; P <0.001), and door-to-provider time decreased by 19.2 minutes (95% CI: 18.8-19.6; P <0.001).
Conclusions:
In our pediatric ED, implementation of a rapid assessment team was associated with reduced LOS, LWBS rates, and door-to-provider times.
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