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.
Published In/Presented At
MacKenzie, R., Burmeister, D., Brown, J., Teitsworth, M., Kita, C., Dambach, M., Shamji, S., Kurt, A., Friend, S., & Greenberg, M. (2013, October 14-17). Implementation of a rapid assessment init (Intake Team): Impact on emergency department length of stay. Poster presented at: The 2013 American College of Emergency Physicians (ACEP) Scientific Assembly, Seattle, WA.
Poster presented at: The Pennsylvania Chapter of American College of Emergency Physicians (PaACEP), Harrisburg, PA. (April 8,2014)
Full results of this study are published in:
Annals of Emergency Medicine - October 2013 (Vol. 62, Issue 4, Supplement, Pages S12-S13, DOI: 10.1016/j.annemergmed.2013.07.315)
Emergency Medicine | Medical Specialties | Medicine and Health Sciences
Department of Emergency Medicine, Department of Emergency Medicine Faculty, Patient Care Services / Nursing
Second place poster presentation won by Shaheen Shamji, DO at the PaACEP, Harrisburg, PA.