Evaluation of an innovative "Emergency Department Surge" program for the care and treatment of patients with low-acuity conditions.

BACKGROUND Emergency Department (ED) crowding negatively impacts healthcare. Numerous strategies have been created to improve treatment of low-acuity conditions to reduce ED crowding and better utilize ED resources.

METHODS We evaluated whether our novel "ED Surge" program within our institution's Care Transition Clinic (CTC), which triages patients with lower-acuity conditions from the ED to our same-day on-site ambulatory CTC, impacted future ED and hospital utilization. Demographics, visit characteristics, and clinical outcomes were evaluated. Bivariate and multivariate analyses assessed associations between patient, visit, and outcome characteristics. Significance was defined as p < 0.05.

RESULTS The ED Surge program saw 727 unique patients and 762 scheduled visits with 76% completion across 31 months of operation. Patients were significantly younger (p < 0.01) and insured with Medicaid (p < 0.01) than the general ED population. This population also experienced a significant decrease in 30-day post-appointment ED utilization (0.08 post-versus 0.2 pre-mean visits, p = 0.01) than those who did not complete an appointment. We also identified several diagnoses that may be better served in the ED as opposed to the ambulatory setting.

CONCLUSIONS Innovative clinics such as our "ED Surge" program held within ambulatory care sites such as the CTC can be a useful tool to impact future ED utilization of patients with low-acuity conditions. Care should be taken to design the clinic to an ED's specific population needs (such as underserved patient groups) and refine it according to how the clinic's patient outcomes develop to optimize patient care and safety.