Background: The hospitalist model (HOS) setting at wards can improve quality of patient care and shorten length of stay, however, their efficacy at emergency department (ED) is still lacking in Taiwan.Objective: To realize if HOS is working at ED in a designed academic care program.Design/setting: Before-and-after intervention of HOS in a 1200-bed tertiary medical center in Taiwan. Measurement:A three-shift duty with 8 internal subspecialists was adapted for their working schedule in 3:1:1 physicians round. From 2012~2016, 4 years data was collected retrospectively such as length of stay, over-waiting (>48 h) period, mortality, 6 and 24 h deterioration after hospitalization and satisfaction questionnaire were analyzed before and after HOS intervention was compared.Results: There was no significant difference in patient number, age and sex before and after HOS program at ED. In total, 4 years data analyzed (520,409 ED visitors, 111,949 hospitalized) was shown that decline of waiting time, over-waiting (>48 h), mortality rate, post-hospitalized 6 and 24 h transferring to intensive care unit were statistically significant (ANOVA, p ≦ 0.05 individually). In average 55-60 patients per month discharged from holistic care unit without admission. Satisfactory questionnaire for pre-hospitalized care in disease explanation, service attitudes, symptom relief and overall impression about healthcare reached 90% in two times survey (427 and 459 sample sizes).Conclusion: HOS at ED can lessen over-crowded conditions, shorten pre-hospitalized length, decline mortality, and improve quality of care and patient satisfaction. Although data comes from a single medical center, it still shows good efficiency and outcome since HOS implemented at emergency. of care model, hospitalist program-HOS, was launched by the hospital administrators to solve the over-crowded situations and cared pre-hospitalized patients in advance at ED. Application of Integrated MedicalThe HOS was established in United Stated (US) in 1996 and the field of hospital medicine has grown rapidly worldwide recently. At present hospitalists on staffs reach 50,000 physicians, more than cardiologists, in almost all medical centers in US [9][10][11][12]. The advantages of HOS include a more rapid, effective and precise dealing with problems no matter in diagnoses, prescription of medications, therapeutic strategies or the communications with patients by sharing decision making with attending physicians rather than by residency in advance [13,14]. Several studies have reported that HOS model at wards provides shorter length of stay and improves quality of care [11,[14][15][16]. From patient point of views,

Objective: A medical center in Taiwan established a Holistic Care Unit (HCU) in the emergency department (ED) to care for emergency patients while they wait for admission. Its goal was to prevent patient conditions from worsening, shorten the ED length of stay for admission, reduce complaints and disputes, and raise the quality of care. Design:If emergency physicians suggested that a patient be admitted, the patient was then transferred to the HCU. The 24-hour work day for the HCU was split into three eight-hour shifts during which on-duty physicians continued any unfinished treatments or follow-ups and accepted new patients. Results:The HCU's intervention in the ED and coordination with inpatient care significantly reduced the rate of access block from 55.29% to 50.01% (p<0.01). In addition, the ED length of stay for admission was significantly decreased from 17.06 hours to 14.13 hours (p=0.018). The percentage of patients whose condition improved while waiting for admission to the ED and who could then be released after treatment by the HCU rose from 1.3% to 4.3%. Conclusions:The HCU at this medical center is the first of its kind to combine emergency and inpatient care in Taiwan. Overcrowding was improved after establishment of the HCU at our hospital.