Background: Emergency department (ED) crowding has been proven to worsen outcomes and increase mortality for patients presenting to the ED. Our innovative ED Surge program works collaboratively with our ED to transfer lower acuity patients to an on-site, same-day ambulatory setting after initial evaluation in the ED. We aim to characterize the impact of our ED Surge program, while also improving care by identifying patients that may be better served in the ED.
Methods: The University of Chicago ED Surge program began in March 2021 within our ambulatory Care Transitions Clinic (CTC). Eligible patients in the ED were screened by advanced practice nurses based on their acuity and reason for the visit and transferred to the CTC. Collected data included demographics, visit characteristics, ED visits and hospitalizations occurring post-ED Surge visit. Frequencies were calculated for all demographic variables except for age, for which mean and standard deviation (SD) were calculated. Significant differences between groups were assessed with chi-squared or t-test analysis. Logistic regression was used to model predictions for visit severity (visit that required admission or return to the ED), high healthcare utilization, and appointment status. Survival analysis using Kaplan-Meier estimator with a log-rank test was used to determine if significant differences existed between groups when examining days until the next ED visit or next inpatient admission. Significance was defined by p< 0.05 with Bonferroni corrections as appropriate.
Results: Our analysis ran from March 2021 to March 2022 with 283 scheduled ED Surge visits, 200 completed visits, and 280 unique patients. Most patients were female (57%), identified as Black/African American (92%), did not identify as Hispanic or Latino ethnicity (96%), had a mean age of 35.8 years (SD 15.5) and were insured by Medicaid (60%). In logistic analysis, we found that those who completed their appointment were more likely to be insured by Medicaid (OR 2.97; 95% CI [1.4, 6.2]). Additionally, higher severity visits were predicted by neurological complaints (OR 18.5; 95% CI [1.6, 209.7]) or dehydration/lab abnormalities (OR 31.66; 95% CI [7.0, 143.8]). Patients presenting with COVID complaints (p=0.003) or neurologic complaints (p< 0.001) were more likely to have a shorter time to the next ED visit, and patients presenting with musculoskeletal complaints (p=0.002) kidney/urine complaints (p< 0.001), or dehydration/lab abnormalities (p=0.02) were more likely to have a shorter time to the next inpatient admission.
Conclusions: In the first year of operation, the ED Surge Program reduced patient burden in the ED. The ED Surge Program serves a majority of younger, Black, and government or uninsured patients. Furthermore, patients who presented with certain diagnoses such as COVID-19, neurological complaints, dehydration/lab abnormalities, musculoskeletal complaints, and kidney/urine complaints seemed to predict the need for the ED rather than outpatient care.