Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: The rapid assessment zone is a newer model for optimizing emergency department (ED) throughput. Similar models implemented in adult ED settings have shown improvements in throughput parameters. However, few studies have taken place in the pediatric ED setting. Our study objective was to assess the impact of implementing a rapid assessment zone on throughput in an urban pediatric ED. We hypothesized that length of stay (LOS), time to bed placement, and time to see a clinician would decrease after the intervention and remain sustainable over long-term follow-up.

Methods: This retrospective study assessed the effect of rapid implementation from May 2012–April 2018 on LOS for ED visits for three two-year time periods: pre- and post-rapid assessment zone and post-follow-up. Our primary outcome measures were LOS, time from registration to bed, and time from registration to first clinician evaluation. Secondary outcome measures were how LOS differed between high- and low-acuity visits. We analyzed data using Kruskal-Wallis for comparison of medians and Wilcoxon rank-sum tests with Bonferroni correction for pairwise comparisons.

Results: There were 304,318 unique ED visits from May 1, 2012–April 30, 2018, with an increase in volume over time (92,551 visits pre-rapid assessment zone and 106,530 visits post-follow-up). Overall median LOS decreased from pre- rapid assessment zone, post- rapid assessment zone, and post-follow-up, respectively (110 minutes versus 101 minutes vs 94 minutes; P < .001). When stratified by acuity level, low-acuity visit LOS decreased from pre- rapid assessment zone to post- rapid assessment zone to post-follow-up (85 min vs 77 min vs 70 min; P < .001), whereas LOS for higher-acuity levels was, on average, unchanged (144 min vs 149 min vs 143 min for pre-RAZ, post- rapid assessment zone, and post-follow-up, respectively; P < .001). The overall registration to clinician time decreased from 15 minutes to 13 minutes (P < .001) between pre-rapid assessment zone and postfollow-up, which is statistically but not clinically significant.

Conclusion: Implementation of a rapid assessment zone significantly decreased overall length of stay in our pediatric ED despite increased patient volume, especially for lower acuity patients. The rapid assessment zone model can be effective in preventing crowding in a pediatric ED with a large proportion of low-acuity visits.