Background: Like many other health systems, our large, academic, quaternary care center is experiencing a capacity crisis, with increasing number and duration of emergency department boarders. We hypothesized that there is a population of admitted patients who may be appropriately discharged home with timely follow-up and connection with community resources.
Purpose: Our project sought to utilize existing Hospital Medicine physician resources to collaborate directly with Emergency Medicine physicians in an effort to identify safe and appropriate outpatient dispositions for patients who were initially recommended for hospital admission.
Description: In collaboration with Emergency Department leadership, a daytime Hospitalist admitter at our adult hospital was encouraged, based on their clinical judgment, to reconsider admission requests for appropriate patients. The Hospitalist admitter was given a designated workspace in the Emergency Department to work directly with ED providers to troubleshoot barriers, facilitate care, and determine appropriate dispositions for patients. Prospective data collection was performed using RedCap® database. Between 9/8/2022-9/30/2022, the Hospital Medicine admitter redirected a total of 21 intended medicine admissions to home with appropriate outpatient care. A chart audit of 17 cases showed that 15 (88.2%) patients remained outpatient for at least 7 days following the ED visit, 1 (5.9%) returned to the ED within 3 days for the same issue but was not admitted, and 1 (5.9%) subsequently required admission to the hospital.
Conclusions: Having a physical presence of Hospital Medicine faculty in the ED has resulted in a safe and effective reduction in admissions to general medicine services. We hypothesize that this reduction is mediated by a.) Hospital Medicine expertise in patient triage, b.) Hospital Medicine’s institutional knowledge of available ambulatory and inpatient resources, c.) improved communication between Hospital Medicine and Emergency Department physicians and d.) a willingness for partnership in this process. In light of this data, the new process shows early promise to improve capacity in an effective and safe manner.