Changes in low-acuity patient volume in an emergency department after launching a walk-in clinic

Abstract

Objective: Unscheduled low-acuity care options are on the rise and are often expected to reduce emergency department (ED) visits. We opened an ED-staffed walk-in clinic (WIC) as an alternative care location for low-acuity patients at a time when ED visits exceeded facility capacity and the impending flu season was anticipated to increase visits further, and we assessed whether low-acuity ED patient visits decreased after opening the WIC.

Methods: In this retrospective cohort study, we compared patient and clinical visit characteristics of the ED and WIC patients and conducted interrupted time-series analyses to quantify the impact of the WIC on low-acuity ED patient visit volume and the trend.

Results: There were 27,211 low-acuity ED visits (22.7% of total ED visits), and 7,058 patients seen in the WIC from February 26, 2018, to November 17, 2019. Low-acuity patient visits in the ED reduced significantly immediately after the WIC opened (P = 0.01). In the subsequent months, however, patient volume trended back to pre-WIC volumes such that there was no significant impact at 6, 9, or 12 months (P = 0.07). Had WIC patients been seen in the main ED, low-acuity volume would have been 27% of the total volume rather than the 22.7% that was observed.

Conclusion: The WIC did not result in a sustained reduction in low-acuity patients in the main ED. However, it enabled emergency staff to see low-acuity patients in a lower resource setting during times when ED capacity was limited.

Keywords: care use; clinical operations; emergency department; emergency department census; emergency department overcrowding; emergency department patient volume; low‐acuity; unscheduled care; urgent care; walk‐in clinic.

FIGURE 1

Low‐acuity patient visit volume by month and site: main ED pre‐WIC, main ED post‐WIC launch, and WIC. Monthly low‐acuity patient volume in the main ED and WIC from January 1, 2015, to November 17, 2019, aggregated by month. The solid line shows the actual number of patient visits. The dotted line shows each month's average volume in the main ED during the 5‐year period to illustrate the seasonal trends. ED, emergency department; WIC, walk‐in clinic.

FIGURE 2

Examining an interruption the main ED low‐acuity patient visit volume by month between the pre‐ versus post‐WIC launch periods. The y‐axis shows the difference in the actual versus adjusted monthly average for low‐acuity patient visit volume by month. The horizontal dotted line marks a difference = 0, or when the actual and adjusted monthly averages are the same. The blue line represents the patient visit difference. The orange line is the modeled volume trend over time. The left side of the figure (white background) presents the pre‐WIC period. The right side (gray background) presents the post‐WIC launch period. CI, confidence interval; WIC, walk‐in clinic.

FIGURE 3

Distribution of patient arrivals by time of day: main ED low‐acuity and WIC. This figure shows the proportion of main ED low‐acuity and WIC patients arriving for care during the course of a day. ED, emergency department; WIC, walk‐in clinic.