Ambulatory care by on-call teams in an Emergency Department

Abstract

Aim
Admission rate is a key performance indicator for Emergency Departments (EDs). Senior hospital management advised that, if discharge by on-call teams was possible within 24 hours, a patient should be termed ‘ambulatory’ and remain in the ED under the care of the on-call team rather than being admitted to a ward. This study aimed to assess the impact of this initiative on ED admission rates and occupancy.

Methods
A pre- and post-intervention single site study over a seven-year period of the impact of this ambulatory care initiative on ED admission rates (number of patients admitted from ED/total attendances to ED) and occupancy (number of patients in the ED/number of clinical care spaces) was performed using Python and SPSS.

Results
Over the study period the admission rate increased. Statistically significant differences (p<0.05) between the pre-intervention admission rate of 26±0.2% (32,587 admissions; 123,662 attendances), the during intervention rate of 26±0.4% (26,453 admissions; 102,048 attendances) and the post-intervention rate of 27±0.2% (51,127 admissions; 188,430 attendances) were found. Of the 30-35 available clinical spaces in the ED, occupancy at 08:00 each day increased from 95±1% (28.6±0.4 patients) pre-intervention to 112±2% (39.1±0.5 patients) post-intervention (p<0.001). The proportion of patients still in the ‘referred’ category at 08:00 each day increased three-fold.

Discussion
Ambulatory care in the ED by the on-call teams did not reduce ED admission rates. Occupancy increased significantly over the study period. On-call teams performing extended workups of ‘referred’ patients in the ED occupies clinical space required for the assessment of newly arriving patients by the emergency medicine team.