Impact of an Express Admit Unit on Emergency Department Length of Stay

Background: Express admit units (EAUs) have been proposed as a way to expedite patient flow through the Emergency Department (ED). Objectives: We sought to determine the effect of opening a five-bed EAU unit for temporary placement of admitted patients on our ED length of stay (LOS) and waiting room times (WT). Method: This was a before-and-after interventional study of the 3-month period immediately before (pre-EAU) and after opening (post-EAU) of the EAU. We compared ED LOS and WT for patients admitted and discharged from the ED for both time periods, controlling for daily census and patient acuity. Results: During the post-EAU period, 386 patients (26.2% of total admits) were admitted through the EAU. Overall LOS decreased from 8:21 (interquartile range [IQR] 6:02–11:20) to 7:41 (IQR 5:22–10:16) for all admitted patients (p < 0.001), and from 3:41 (IQR 2:05–5:58) to 3:35 (IQR 2:00–5:55) for the discharged patients (p = 0.025). After controlling for census and acuity, the LOS decreased an average of 10% (95% confidence interval [CI] 6%–14%; p < 0.001) for admitted patients and 4% (95% CI 2%–7%; p = 0.001) for discharged patients. These changes represented a decreased LOS of about 50 and 9 min, respectively. There were no significant differences in WT (0:44; IQR 0:09–2:07 vs. 0:50; IQR 0:11–2:20 for admitted patients and 0:41; IQR 0:09–1:50 vs. 0:41; IQR 0:10–1:47 for discharged patients). However, after controlling for census and acuity, WT decreased 9% (95% CI 1%–16%; p = 0.022) for discharged patients, which represented a decrease of about 4 min. Conclusions: With an EAU, there was a modest improvement in ED LOS despite an overall increase in daily ED volume.