The quick response initiative in the emergency department: who benefits?
OBJECTIVES: This collaborative project between two community hospitals, a Metropolitan Home Care Program and the University, was designed to quantify the applicability (who is eligible for) and acceptability (who will likely comply with) Home Care services, provided through a Quick Response Program (QRP) initiative as compared to usual hospital care services, to patients, families and physicians. METHODS: During a 6 week period of sampling (5 days per week, 8 hours per day) in two Emergency Departments (ED) in moderately sized community hospitals in a major metropolitan city, all patients triaged to the urgent category were assessed for eligibility for QRP services by on-site Home Care Coordinators using specific criteria. Patients meeting the criteria initially were reviewed by the ED physician for approval for QRP services and then randomized to experimental and control conditions. Patients not meeting the eligibility criteria were managed by the usual ED services procedures. Demographic and clinical data were obtained on all urgent category patients at presentation to the ED. Additionally, the nature and cost of all health care services used by the ED patients during the ED event and 10 days follow up, were obtained through hospital and Home Care record abstraction and compared among the different sample groups. RESULTS: The QRP Initiative was applicable to 2% of the total ED patient population and 5% of the urgent category of patients triaged in the ED. It was acceptable to 97% of this eligible group. One hundred and fifty-five patients who initially qualified for QRP were excluded from eligibility at a subsequent assessment. Ninety of these patients were admitted to hospital and 65 were discharged home. In the total "exclusion" group, 37 refused Home Care services including the QRP. HEALTH CARE PRACTICE IMPLICATIONS: The sampling results raise important questions about broader system issues concerning the role of the hospital and community in providing health care services and the social value or utility that guides the allocation of health care funds. What level of applicability and acceptability would justify priority services for certain target groups. In the future, policy makers will need to be able to show that it is in the best interest of patients and society to prioritize mixtures of services to certain target groups.