O1020: Impact of a Front-End Care Initiation System on Patient Experience Metrics in a Pediatric Emergency Department

Background: Front-end care initiation (CI) systems that utilize providers to begin patient evaluation are widely described in adult emergency departments (ED) and have been shown to reduce wait times and improve patient flow. These systems are novel in pediatric EDs with only a few documented in the literature. The impact of a CI system on patient experience metrics is unclear. Our pediatric ED implemented a CI system in October 2023. The objective of this study was to understand how CI affects patient and family experience and to evaluate its impact on throughput measures in our department.

Methods: We conducted a matched retrospective cohort study to evaluate the impact of CI on patient experience metrics and ED throughput. Patients seen through CI from October 2023-June 2024 who completed the NRC Health Real-Time Patient Survey were included. Controls were matched based on ED arrival date/time and Emergency Severity Index (ESI) score with 1:1 matching for ESI levels 2 and 3 and 2:1 matching for ESI levels 4 and 5. Our primary outcome was the Net Promoter Score (NPS), a metric used to measure patients’ likelihood of recommending our facility, calculated by subtracting the percentage of detractors (scores 0-6) from the percentage of promoters (scores 9-10) on a 0-10 scale. Our secondary outcomes were length of stay (LOS), pain scores, medications administered, labs and imaging ordered, and NRC survey results. The Wilcoxon rank sum test, Pearson’s Chi-squared test, and Fisher’s exact test were used for the analysis.

Results: 366 patients were included in the CI cohort with 61 patients excluded due to inadequate matches. 585 patients were included in the control cohort. The CI cohort was older (median = 6.8 y, IQR (2.3, 11.6)) than the control cohort (median = 5.2 y, IQR (1.8, 11.3); p = 0.023). There was a greater proportion of Spanish speaking patients in the CI cohort (p = 0.006). Median length of stay was significantly shorter for the CI cohort (median = 133 min, IQR (87, 202)) than the control cohort (median = 172 min, IQR (122, 327); p < 0.001 (Table 1)). NPS was significantly higher in the CI cohort (65.0) compared to the control cohort (54.3); p = 0.029 (Table 2). Patients in the CI cohort reported significantly better experiences in several domains, including timely care, relief of discomfort, consistent information, and clarity of medication instructions (Table 2).

Conclusion: The CI cohort had a higher NPS score, suggesting that this system is related to an increase in patient satisfaction. NRC survey results favored CI across multiple metrics, including timeliness, communication, easing discomfort, and clarity of instructions. Additionally, the CI group had shorter ED stays. This process is associated with an improvement in both patient experience metrics and our ED throughput.