Initiating workups in the waiting room decreases emergency department bed time and left before completion of service rate

Study Objectives: Emergency department (ED) crowding and long wait times are challenging issues. There is little evidence as to the impact of clinician rapid screening exams on ED throughput, and, in particular, the effect of ordering tests on patients still in the waiting room is unknown. This study aims to determine the effect of initiating laboratory and imaging studies from the waiting room on patient total time in the ED, time in an ED bed, and the likelihood of leaving before their evaluation is complete, ie, left before completion of service (LBCS). Methods: Prospective, randomized controlled trial evaluating 700 non‐pregnant adults with a chief complaint of abdominal pain conducted in a public hospital with an annual census of 55,000. This is a preliminary report on a larger ongoing study. After a standard brief screening exam by a physician or trained ED nurse practitioner, patients who were stable to remain in the waiting room were randomized to either “no testing” or “testing” groups. Patients in the “no testing” group returned to the waiting room to await definitive evaluation in the ED. Patients in the “testing” group had laboratory and imaging studies ordered if warranted. The primary outcome was time from arrival to disposition. Secondary outcomes were time in an ED bed and rate of LBCS. T tests and Chi Squares were used to compare outcomes where appropriate. Results: Between August 2014 and November 2015, 700 patients were enrolled and 586 completed the study. There were 301 patients in the “no testing” and 285 in the “testing” group. There were no differences in baseline demographics. Mean time in the ED was 8.7 hours (SD: 3.5) for the “no testing” group and 8.4 hours (SD: 3.9) for the “testing” group (P = .149). Mean time spent in an ED bed was 4.7 hours (SD: 2.25) for the “no testing” group, compared to 4.4 hours (SD: 2.58) for the “testing” group (P = .011). Of the 700 patients enrolled, 82 patients LBCS. Among these patients, 52/369 or 14% of patients in the “no testing” group LBCS compared to 30/ 325 or 9% of those in the “testing” group (P = .047). Conclusion: There was no statistically significant difference in total ED time between the groups. Waiting room order entry did reduce time spent in an ED bed and LBCS rates. Because ED bed real estate is a valuable commodity, initiating workups from the waiting room may increase efficiency and decrease the number of patients who leave before completion of their evaluation.