SHM Converge Scientific Abstract ePoster Gallery-Breaking the Bottleneck: A Resident-Run Initiative to Advance Care for Emergency Department Patients Awaiting Admission

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The document describes a resident-run initiative at UNC Hospitals called the Medicine Care Advancement Team (MCAT) created to address emergency department (ED) boarding and delayed admission for patients awaiting medicine inpatient beds. ED boarding times had risen sharply since 2022, from an average of 109 to 238 minutes, driven mainly by limited bed availability, inpatient staffing constraints, and slowed throughput. The team was designed as a consult service between the ED and inpatient medicine to provide earlier inpatient-level care while patients remained in the ED.<br /><br />MCAT became active in July 2024 and, over its first nine months, managed 1,304 patient encounters, averaging 4.8 per day. Most consults occurred overnight, between 10 p.m. and 5:30 a.m., when inpatient services were full. Outcomes show that 13.5% of patients consulted by MCAT were directly discharged from the ED, suggesting that some admissions were avoided and resources could be redirected to sicker patients. Overall, 77.4% were admitted, 8.6% placed in observation, and 0.5% went to other services.<br /><br />The initiative appears to have improved efficiency by accelerating care progression and reducing delays associated with boarding. The authors report a 21% reduction in associated care delay, from 19 hours to 15 hours from ED arrival, and a decrease in a secondary peak related to admitted-patient flow. Beyond operational benefits, MCAT also offers educational value for resident house staff, giving experience in triage, resource allocation, inpatient versus observation decisions, and outpatient care pathways.<br /><br />The authors conclude that MCAT is a creative, partial solution to a systemic boarding problem. It does not fix root causes like bed shortages or staffing limitations, but it helps advance care, reduce unnecessary admissions, and improve ED throughput.

Asset Subtitle

Aaron Fried

Meta Tag

Author List Aaron Fried, Andrew J. Donohoe, Cristin Colford, David Hemsey, Emma Bick, Jacob Amburn, Portia Nleya

Category Innovations

Concept Emergency Department Boarding

Concept Emergency Department Crowding

Concept Medicine Care Advancement Team

Concept Direct Discharge

Concept Delay in Care

Distinguished Finalist

Presenter Organization University of North Carolina at Chapel Hill School of Medicine

Presenting Author Aaron Fried

Track Quality Improvement

Keywords

emergency department boarding

delayed admission

medicine inpatient beds

resident-run initiative

consult service

UNC Hospitals

patient throughput

observation status

admission avoidance

care delay reduction

Emergency Department Boarding

Emergency Department Crowding

Medicine Care Advancement Team

Direct Discharge

Delay in Care