WIP 71 - Evaluating the Effectiveness, Safety, and Equity of an Inclusive Direct Admission Protocol

Publication Number: WIP 71.7464

Jessica D. Jones, University of Washington School of Medicine, Bellevue, WA, United States; Colin Bowles, Seattle Children's, Seattle, WA, United States; Amber R. Hyatt, Seattle Children's, Mill Creek, WA, United States; Corrie E. McDaniel, University of Washington, Seattle, WA, United States; Lauren M. McDaniel, University of Washington School of Medicine, Seattle, WA, United States

Background: Direct admissions to a hospital (i.e., without requiring evaluation in the admitting hospital’s emergency department) improve family satisfaction and timeliness to care, while decreasing costs and emergency department overload. Studies on the implementation of direct admission protocols highlight wide variations in implementation and disparities in direct admission rates by race and ethnicity, insurance type, and medical complexity. In June 2023, our tertiary-care children’s hospital implemented a direct admission protocol with intentionally broad inclusion criteria.

Objective: This study aims to 1) compare direct admission rates before and after implementation of an inclusive direct admission protocol, 2) investigate the relationship between admission type, frequency of clinical deterioration, and timeliness of medical care, and 3) evaluate disparities by socio-demographic characteristics.

Design/Methods: We implemented an inclusive direct admission protocol in June 2023, in which all patients regardless of age or diagnosis are eligible for direct admission to our free-standing, tertiary care children’s hospital. Moving forward, patient-level data will be extracted from the electronic medical record for all unscheduled admissions to the acute care units, comparing direct admissions to admissions through the emergency department (ED), from 1/1/2022-9/30/2024. We will conduct an interrupted time series analysis to assess the impact of protocol implementation on the rate of direct admission, including stratification by age, race/ethnicity, insurance, language, and medical complexity. Balancing measures will assess the frequency of clinical deterioration (rapid responses and intensive care unit transfers) and timeliness of medical care (time to first vital signs). The study has been approved by our institution's IRB. Data extraction and analysis are underway and will be completed by March 2025.