Impact of Inpatient Care in Emergency Department on Outcomes: A Quasi-Experimental Cohort Study

BACKGROUND: Hospitals around the world are faced with the issue of boarders in emergency department (ED), patients marked for admission but with no available inpatient bed. Boarder status is known to be associated with delayed inpatient care and suboptimal outcomes. A new care delivery system was developed in our institution where boarders received full inpatient care from a designated medical team, acute medical team (AMT), while still residing at ED. The current study examines the impact of this AMT intervention on patient outcomes. METHODS: We conducted a retrospective quasi-experimental cohort study to analyze outcomes between the AMT intervention and conventional care in a 1250-bed acute care tertiary academic hospital in Singapore. Study participants included patients who received care from the AMT, a matched cohort of patients admitted directly to inpatient wards (non-AMT) and a sample of patients prior to the intervention (pre-AMT group). Primary outcomes were length of hospital stay (LOS), early discharges (within 24 h) and bed placement. Secondary outcomes included unplanned readmissions within 3 months, and patient’s bill size. χ2- and Mann-Whitney U tests were used to test for differences between the cohorts on dichotomous and continuous variables respectively. RESULTS: The sample comprised of 2279 patients (1092 in AMT, 1027 in non-AMT, and 160 in pre-AMT groups). Higher rates of early discharge (without significant differences in the readmission rates) and shorter LOS were noted for the AMT patients. They were also more likely to be admitted into a ward allocated to their discipline and had lower bill size compared to non AMT patients. CONCLUSIONS: The AMT intervention improved patient outcomes and resource utilization. This model was noted to be sustainable and provides a potential solution for hospitals’ ED boarders who face a gap in inpatient care during their crucial first few hours of admissions while waiting for an inpatient bed

Additional file 1: Appendix 1–3. of Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study

Descriptive statistics of Pre-AMT, AMT, and Non-AMT enrolled patients. Appendices 1, 2, and 3 report the descriptive statistics for age, Charlson Co-morbidity Index, number of primary DRG codes, 3-MinNS, Katz Functional Score, Length of Stay, and bill size of Pre-AMT, AMT, and Non-AMT patients in the study period (March 2013 to January 2015). (DOCX 17 kb

Additional file 2: Appendix 4–5. of Impact of inpatient Care in Emergency Department on outcomes: a quasi-experimental cohort study

Regressions of AMT enrollment as a predictor of early discharge and inpatient bed placement. Appendix 4 reports on the logistic regression of AMT enrollment status on early discharge, after controlling for time of enrollment, age, gender, DRG, CCI, 3-MinNS, and Katz Score. The change in R2 reports on the statistically significant additional variance explained (18%) by AMT enrollment, after accounting for the effects of the control variables. The results indicate faster discharge for AMT patients, relative to pre-AMT and non-AMT patients. Appendix 5 reports on the multinomial regression of AMT enrollment status on inpatient bed placement, after controlling for time of enrollment, age, gender, DRG, CCI, 3-MinNS, and Katz Score. The change in R2 reports on the statistically significant additional variance explained (more than double) by AMT enrollment, after accounting for the effects of the control variables. The results indicate improved bed placement for AMT patients, relative to pre-AMT and non-AMT patients. (DOCX 18 kb