Effect of a rapid assessment clinic on the waiting time to be seen by a doctor and the time spent in the department, for patients presenting to an urban emergency department: a controlled prospective trial.

AIMS: To test the hypothesis that triaging certain emergency department (ED) patients through a rapid assessment clinic (RAC) improves the waiting times, and times in the department, for all patients presenting to the emergency department.

METHODS: For ten weeks an additional nurse and doctor were rostered. On the odd weeks, these two staff ran a RAC and on even weeks, they did not, but simply joined the other medical and nursing staff, managing patients in the traditional way. Patients suitable for triage to the RAC were those for whom disposal was readily apparent, interventions required were quickly undertaken, and lengthy investigations or assessment were not required. After the ten-week period data from the five weeks of the RAC and the five weeks with no RAC, but the same staffing level, were analysed and compared.

RESULTS: During the five weeks of the RAC clinic a total of 2263 patients attended the ED, and 361 of these were referred to the RAC clinic. During the five control weeks a total of 2204 patients attended the ED. There was no significant difference in the distribution across triage categories between the RAC and non-RAC periods. The waiting times to be seen by a doctor show no difference at Triage 2 and 3 and a difference of several minutes for Triage 4 and 5 categories. The times patients spent in the ED also show no difference for Triage 2 and 3 and about 20 to 25 minutes advantage for RAC-week patients in Triage categories 4 and 5.

CONCLUSIONS: The rapid management of patients with problems which do not require prolonged assessment or decision making, is beneficial not only to those patients, but also to other patients sharing the same, limited resources.