Intervention features
| Domains | Intervention features | Exemplar quotes |
| Population | Defining less acute cases | ‘…. So if you're a certain priority population or condition, there’s fast tracks to get people in and out quickly. … I took my son, for example, he had a pretty scary fall. Diagnosed pretty much by the triage nurse. He was in an out quite quickly because they know it’s quick-turnaround condition. He was in and out within that hour and a half. Same condition, different hospital: he was there for three hours and took up a bed that someone was in the waiting room waiting for.’ (2110) |
| Defining mid-acuity cases of unknown severity | ‘[Some] people come in and they may be full out flat cardiac arrest. You’re not breathing, your heart isn’t beating; we need immediate resuscitation. Then there are the other groups of people that we don’t know what’s wrong with you. Your pain could be life-threatening or it could be food poisoning. So it was that group, the unknown, but potentially very serious that this intake model was built to address.’ (5201) | |
| Defining patients who require a process of care of 24–48 hours | ‘… to try to look at patients that stay a long time in the ED that really shouldn't be cared for in an ED and looking at where the best place for that patients would be Like GI bleeds that are stable, for example, like, they shouldn’t be prepped in an ED. They should be someplace else for that. So there’s at least [a starting point] to identify those populations and potentially [move them] into a CAU or somewhere else to look after them. … [where] they can be cared for there and then either discharged or admitted for longer.’ (10112) | |
| Capacity | Dedicated space | ‘And, really the idea is: pulling patients into a designated area … a department that [is] sort of your mid-acuity patients. … So trying to prioritize those patients, get them in front of a physician early …and so minimize the time that they’re actually in a treatment room.’ (9106). |
| Dedicated clinical resources | ‘…And then we try to have a physician dedicated to that area for the first two hours of their shift. So, if a physician is in one space in the Emergency Department in terms of flow, it’s way more efficient [to] have all your patients and your nurses in close proximity, and your exam rooms.’ (5211) | |
| Process | Rapid cycle time | ‘ …So we direct those patients to Intake and the way Intake works is you have a number of stretchers which are necessary for evaluating patients, but they’re used in a touchdown mode, meaning that the patients are brought in quickly and they’re quickly assessed by the physician and they’re taken out of the stretcher. So it’s kind of a rapid cycle, quick assessment area.’ (5219) |
| Rapid and targeted discharge planning | ‘I'm talking about your frail elderly population, right. … [Within] 72 hours if you can actually get in there and have some home support set up and a quick OT assessment at home to reduce the risk on the falls, the doc will …sign off on the discharge plan.’ (4110) | |
| Having a strict time frame | [How to ensure that it didn’t become a parking lot] ‘They did try to keep rules around, you really don’t want a patient in the Diagnostic Treatment Unit for more than 48 hours, better yet not more than 24 hours and probably a dozen is more, like right.’ (1119) |