Embedded Low-Acuity Pathway in the Emergency Department: An Alternative to Stand-Alone Urgent Care Services.

Objectives

To evaluate the impact of an embedded Ultra-Low Acuity Pathway (ULAP) on emergency department performance indicators for low-acuity patients in a rural referral hospital.

Methods

This pragmatic, single-centre, quasi-experimental study included Australian Triage Scale Categories 4 and 5 patients presenting to Dubbo Health Service between 10:00 and 20:00 from 29 May to 1 October 2023 (n = 4798). Workforce-dependent ULAP availability created a comparison between ULAP (n = 2178) and standard care periods (n = 2620). Primary outcomes were Did Not Wait (DNW), Seen Within Benchmark (SWB), Emergency Treatment Performance (ETP) and length of stay (LOS). Multivariable analyses adjusted for patient characteristics, temporal factors and resource state.

Results

ULAP was associated with improvements across all outcomes. DNW decreased from 14.2% to 6.9% (adjusted OR 0.43, 95% CI 0.35-0.53), SWB increased from 72.6% to 82.0% (adjusted OR 1.90, 95% CI 1.64-2.20) and ETP increased from 73.1% to 83.3% (adjusted OR 1.96, 95% CI 1.69-2.28). Mean LOS was 51.7 min shorter after adjustment (95% CI -65.1 to -38.4). All associations remained statistically significant (p < 0.001).

Conclusions

An embedded ULAP was associated with substantial improvements in emergency department performance that were independent of patient characteristics, temporal factors and resource state. Embedding urgent care within existing emergency departments may provide a practical alternative to stand-alone urgent care services for rural communities where separate services are not feasible.