The Impact of Interim Care Plans for Direct Inpatient Admissions on Emergency Department Length of Stay: A Retrospective Single-Site Matched-Cohort Study

Abstract

Objective

Investigate the effect of interim care plans (ICP) for direct inpatient general medical and cardiology admissions on Emergency Department (ED) length of stay (LOS), and whether ICP were associated with adverse patient outcomes.

Methods

This was a single-site retrospective study across 12 months in 2023, where ICP was implemented from 1st January. Adults presenting to ED and admitted under general medicine or cardiology, but not requiring high dependency unit care, were included. Patients admitted under ICP (ICP group) were matched to those admitted without ICP (NO-ICP group) via variable ratio up to 1:4 (ICP:NO-ICP) based on age (±10 years), sex, date of presentation (±7 days) and presentation time (day, evening or night). Patients in the NO-ICP group were excluded if vital signs at the time of triage or referral did not fulfil the ICP criteria. The primary outcome was ED LOS, with secondary outcomes including time to inpatient referral, time to bed booking, hospital LOS, and Medical Emergency Team (MET) calls within 24 h after referral.

Results

ICP facilitated admissions were associated with shorter ED LOS compared with admissions without ICP (ICP 535.16 [342.28–728.03] min (median [interquartile range]); NO-ICP 995.00 [642.49–1347.51] min, p < 0.001). However, there was no difference in total hospital LOS (p = 0.28) or rate of adverse events between ICP and NO-ICP groups (Odds ratio 0.73; 95% confidence interval 0.24–2.21).

Conclusion

This single-site study suggests that the ICP model of care for direct inpatient admissions was associated with reduced ED LOS, without increasing adverse outcomes for patients.