Rapid access clinics: Improving the efficiency of referral after discharge from the Emergency Department

Abstract

Background: Rapid access clinics are an increasingly common model of care in tertiary hospitals. Early streaming of suitable patients to appropriate clinic services could reduce Emergency Department overcrowding. This study set out to investigate the current utilisation of rapid access clinic dispositions in a tertiary centre. The findings have led to useful mapping of local services and early nurse led identification of patients suitable for streaming to clinic locations. Methods: A cross-sectional observational study in a tertiary centre. Complete lists of consecutive discharged Emergency Department patients were generated by a trained data manger. Individual electronic medical records were reviewed for evidence of clinic disposition, patient demographics and compared with concurrent Emergency Department patients who were not referred. Results: 1367 patients included from 144 h of consecutive weekday presentations. Referral to clinic locations occurred in 179/1357 (13.2%) with rapid access clinics utilised in 129/179 (70.4%). No difference in median length of stay was observed for patients referred to clinics (3.9 h) versus patients not referred (3.8 h) (p = 0.29). Conclusion: In a tertiary Emergency Department setting, discharged patients were frequently referred to rapid access clinics. Early streaming to suitable outpatient locations may be an additional strategy to consider for mitigating Emergency Department overcrowding.