Publication/Presentation Date

10-2013

Abstract

Implementation of a Rapid Assessment Unit (Intake Team): Impact on Emergency Department Length of Stay

Richard S. MacKenzie, MD, David B. Burmeister, DO, Jennifer A. Brown, RN, Melissa

Teitsworth, RN, BSN, Christopher J. Kita, MEd, Megan J. Dambach, DO, Shaheen

Shamji, DO, Anita Kurt, PhD, RN , Susan Friend, Marna Greenberg, DO, MPH

Acknowledge: Clare M. Lenhart, PhD, MPH

Objective: Emergency Department (ED) crowding is an on-going formidable issue for

many EDs. A Rapid Assessment Unit (RAU) is a potential solution. This process

involves the use of a team approach to convert the current “series” type evaluation to a

more “parallel” evaluation and treatment of patients. The RAU concept of evaluating and

treating ED patients radically changes the current methods utilized in today’s standard

emergency care area.

The RAU concept offers a process in which the patient walks into the ED and is seen in a unit by an intake team composed of a nurse, registrar, and provider (physician assistant, nurse practitioner, or physician) that provides evaluation and emergent treatment. This removes the redundancy of a patient giving the same information several times before they are treated. Simultaneously, the team decides whether the patient would be better served by remaining seated or requires a recumbent position. This is referred to as allowing “vertical flow” versus the default “horizontal flow” where all patients recline on a stretcher whether they need it or not. Certainly, having construction that specifically supports these processes is an innovation as well (having an area where patients can be seated and remain “vertical”).

The team structure itself is unique. The nurses and providers are not assigned geographically by room but rather are defined by their function. We set out to determine if the addition of the RAU process would decreases the LOS of the discharged ambulatory arrival patient.

Methods: After IRB approval, this retrospective, pre- and post intervention, observational

comparison study was conducted from August 2011-March 2012 at a suburban teaching

hospital in central Pennsylvania with an annual ED census of approximately 54,000. The

inclusion criteria were all ambulatory discharged patients. The exclusion criteria were all

patients that arrived by ambulance and admitted patients. Data points captured included:

time of arrival in triage , time in triage to ED entry, time of ED entry until seen by a

provider, time from ED entry to discharge, total length of stay (LOS). The data were

uploaded to Horizon Business Insight™ (HBI), a cumulative data manager and exported

to an Microsoft excel file for analysis. Mann-Whitney U tests were used to demonstrate

differences in Median LOS. All statistical tests were 2-sided; probability values <0.05

were considered significant.

Results: 11, 994 pre and 10814 post-RAU patients were included in analysis. Median LOS was shorter during the post-RAU period in each subcategory of LOS with the exception of the interval from being seen in the ER to discharge which is a result of provider seeing the patient earlier in the ED encounter. Results, Table 1.

Conclusions: The RAU process decreases the LOS of the discharged ambulatory arrival patient and deserves further exploration as an innovative model in the ED that improves flow.

Comments

Copyright © Lehigh Valley Health Network

Disciplines

Emergency Medicine | Medical Specialties | Medicine and Health Sciences

Department(s)

Department of Emergency Medicine, Department of Emergency Medicine Faculty, Patient Care Services / Nursing

Awards

Second place poster presentation won by Shaheen Shamji, DO at the PaACEP, Harrisburg, PA.

Document Type

Poster

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