Senior work-up assessment and treatment team in an emergency department: a randomised control trial

Abstract

Objective: To evaluate the impact of a senior early assessment model of care on performance measures in a single ED.

Methods: A pragmatic single-blinded randomised control trial with day of ED presentation randomised to one of three study arms: senior work-up assessment and treatment (SWAT) model of care intervention, non-SWAT control or control.

Primary outcome: The primary outcomes were the proportion of patients meeting National Emergency Access Target (NEAT) criteria (ED length of stay less than 4 h) and ED length of stay. Secondary outcome measured was time to decision to admit in the subgroup of admitted patients.

Results: A total of 1737 patients were analysed. There was no overall difference in NEAT performance (48% [95% CI 44, 51] vs 41% ([95% CI 37, 45] vs 46% [95% CI 41, 50], P = 0.09) or ED length of stay (P = 0.65) between SWAT, non-SWAT and standard of care control groups, respectively. In the subgroup of patients discharged from ED (non-admitted), the SWAT intervention group was associated with higher NEAT performance (P = 0.004) compared with non-SWAT and control.

Conclusion: A senior early assessment model of care was not associated with improved overall NEAT performance and ED length of stay. However, there is evidence that improvements were made in the subgroup of discharged patients. There was no difference in overall NEAT performance among the three study groups.

Keywords: emergency department; model of care; randomised control trial.