Emergency Department overnight deflection of low acuity patients: A 6-month evaluation of a quality improvement project

Abstract

Background and problem statement: Emergency care services in the United Kingdom (UK) are currently under unprecedented pressure which has resulted in long patient delays. Alternative approaches are therefore required to improve patient experience.

Project aims: Deflection is the process where patients with low acuity presentations are offered the option of returning to an appointment. This project aimed to reduce the Length Of Stay (LOS) by introducing deflection into our Emergency Department (ED).

Methods: Patients with suitable conditions were identified and their predicted ED-LOS was recorded which was then compared to their actual ED-LOS when they returned along with a satisfaction score.

Results: 147 overnight patients were deflected in a 6-month period (1.8%). The mean reduction in the predicted patient ED LOS was 5 h (300 min). The patient reported satisfaction was 4.79 out of 5.

Discussion: Whilst only suitable for a subset of patients presenting overnight to our ED, deflection empowered the nursing team to be able to offer alternatives to waiting.

Conclusion: Within our ED, overnight deflection of patients with low acuity conditions has reduced the overall LOS and improved the experience for suitable patients. This may additionally benefit the wider ED system by reducing congestion in waiting areas and the need for nursing care whilst patients wait.