Pediatric Emergency Medicine Fellow Nicklaus Children’s Hospital Pembroke Pines, Florida, United States
Background: Emergency department (ED) visits have risen substantially causing significant department crowding, prompting development of overcrowd scales and directed efforts to streamline throughput. Challenges include increased length of stay (LOS), left without being seen rates (LWBS), and boarding. Consequences of these challenges include delay in treatment, increased errors, decreased patient satisfaction, and increased mortality. Adult ED's have implemented several strategies to address these issues including use of fast tracks, rapid triaging, or physician lead triaging. There are few available studies in the pediatric ED setting looking at the effect of rapid assessment team models on department operations/throughput. Objective: The primary objective of the study is to compare the LWBS rate and LOS of patients presenting to the pediatric ED before and after implementation of a rapid assessment team (RAT). Design/Methods: Single institution, before/after retrospective study investigating standard efficiency metrics in patients presenting to the pediatric ED, during which time a RAT was implemented. The team consists of an independent ED provider, nurse, and scribe whose sole purpose is to see low acuity patients and patients identified as high risk for LWBS during the visit. Twelve months of data from 3 distinct time periods will be compared: 1. The COVID pandemic, 2. Pre-rapid assessment team, and 3. Post-rapid assessment team. Data will be obtained from the hospital EMR database. The study has been IRB approved. Baseline characteristics of the study sample will be summarized and their distributions compared between patients seen at each period of interest. Bivariate analyses will be used to assess the association between baseline characteristics and the primary outcomes using odds ratios for LWBS rate and differences between means or medians for LOS. Multivariable logistic regression for LWBS rate and linear regression for LOS will be used to examine the association between the 3 time periods and the primary outcomes. The project is expected to be completed by March 2024.
