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{
    "pk": 17626,
    "title": "Impact of Care Initiation Model on Emergency Department Orders and Operational Metrics: Cohort Study",
    "subtitle": null,
    "abstract": "Introduction:\n Emergency departments (ED) employ many strategies to address crowding and prolonged wait times. They include front-end Care Initiation and clinician-in-triage models that start the diagnostic and therapeutic process while the patient waits for a care space in the ED. The objective of this study was to quantify the impact of a Care Initiation model on resource utilization and operational metrics in the ED.\nMethods:\n We performed a retrospective analysis of ED visits at our institution during October 2021. Baseline characteristics were compared with Chi-square and quantile regression. We used t-tests to calculate unadjusted difference in outcome measures, including number of laboratory tests ordered and average time patients spent in the waiting room and the ED treatment room, and the time from arrival until ED disposition. We performed propensity score analysis using matching and inverse probability weighting to quantify the direct impact of Care Initiation on outcome measures.\nResults:\n There were 2,407 ED patient encounters, 1,191 (49%) of whom arrived during the hours when Care Initiation was active. A total of 811 (68%) of these patients underwent Care Initiation, while the remainder proceeded directly to the main treatment area. Patients were more likely to undergo Care Initiation if they had lower acuity and lower risk of admission, and if the ED was busier as measured by the number of recent arrivals and percentage of occupied ED beds. After adjusting for patient-specific and department-level covariates, Care Initiation did not increase the number of diagnostic laboratory tests ordered. Care Initiation was associatedwith increased waiting room time by 1.8 hours and longer time from arrival until disposition by 1.3 hours, but with decreased time in the main treatment area by 0.6 hours, which represents a 15% reduction.\nConclusion:\n Care Initiation was associated with a 15% reduction in time spent in the main ED treatment area but longer waiting room time and longer time until ED disposition without significantly increasing the number of laboratory studies ordered. While previous studies produced similar results with Care Initiation models accessing all diagnostic modalities including imaging, our study demonstrates that a more limited Care Initiation model can still result in operational benefits for EDs. [West J Emerg Med. 2023;24(4)1–7.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Provider in Triage/Front End, ED crowding, ED Length of Stay, Laboratory orders"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/5kf2004p",
    "frozenauthors": [
        {
            "first_name": "Andy Hung-Yi",
            "middle_name": "",
            "last_name": "Lee",
            "name_suffix": "",
            "institution": "Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA;",
            "department": "None"
        },
        {
            "first_name": "Rebecca",
            "middle_name": "E.",
            "last_name": "Cash",
            "name_suffix": "",
            "institution": "Harvard Medical School, Boston, Massachusetts, USA; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA",
            "department": "None"
        },
        {
            "first_name": "Alice",
            "middle_name": "",
            "last_name": "Bukhman",
            "name_suffix": "",
            "institution": "Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA",
            "department": "None"
        },
        {
            "first_name": "Dana",
            "middle_name": "",
            "last_name": "Im",
            "name_suffix": "",
            "institution": "Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA;",
            "department": "None"
        },
        {
            "first_name": "Damarcus",
            "middle_name": "",
            "last_name": "Baymon",
            "name_suffix": "",
            "institution": "Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA",
            "department": "None"
        },
        {
            "first_name": "Leon",
            "middle_name": "D",
            "last_name": "Sanchez",
            "name_suffix": "",
            "institution": "Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA",
            "department": "None"
        },
        {
            "first_name": "Paul",
            "middle_name": "C.",
            "last_name": "Chen",
            "name_suffix": "",
            "institution": "Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA;",
            "department": "None"
        }
    ],
    "date_submitted": "2022-11-02T21:03:14-07:00",
    "date_accepted": "2022-11-02T21:03:14-07:00",
    "date_published": "2023-07-12T13:08:17-07:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/17626/galley/8993/download/"
        }
    ]
}