Improvement in emergency department length of stay using an early senior medical assessment and streaming model of care: A cohort study

Abstract

Objective: Australian EDs are required to conform to the National Emergency Access Target (NEAT): patients must be discharged within 4h of arrival. The aim of the present study was to determine if a model of care called Senior Assessment and Streaming (SAS) would increase the proportion of patients achieving NEAT. Methods: Stable, ambulant patients considered to have problems that early consultant-level assessment was likely to improve processing efficiency were streamed through a dedicated clinical area staffed by an ED physician, intern and nurse. The proportion of patients achieving NEAT were compared between days with or without SAS, adjusted for confounding variables. Results: The 18962 patients presented during the study, 6828 on days with SAS, 12134 on days without. On days with SAS, there were more presentations, more admissions, lower access to ward beds and fewer staff working hours. After controlling for confounding, the odds of meeting NEAT on days with SAS was 15% higher compared with days without (odds ratio, 1.15; 95% confidence interval [CI], 1.07-1.24; P < 0.001). For the subgroups of patients admitted, discharged, triage category 3, 4, 5, or presentation 12.00-18.00 the odds of meeting NEAT on days with SAS was, respectively, 1.10 (95% CI, 0.98-1.23; P = 0.10), 1.17 (95% CI, 1.07-1.28; P < 0.001), 1.17 (95% CI, 1.08-1.27; P < 0.001) and 1.19 (95% CI, 1.06-1.35; P = 0.003). The odds of a patient not waiting to be seen on days with SAS was 28% lower compared with days without (odds ratio, 0.72; 95% CI, 0.58-0.90; P = 0.003). Conclusion: Through the introduction of SAS, the present study has demonstrated that providing early senior medical assessment can improve an ED's ability to meet NEAT. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.