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Establishing An Alternate Care Site (ACS) Within A Pediatric Emergency Department During A Patient Surge.
*Eric De Leon, Debra Rodriguez, Oscar Enriquez, *Eric Higginbotham, Elizabeth Fredeboelling, Kimberly Lewis
Dell Children's Medical Center, austin, TX

BACKGROUND: Respiratory illnesses routinely cause Pediatric Level One Trauma Center winter patient volumes to double. The increase stresses the emergency department (ED) and usual patient care areas become inadequate to meet the demand. The purpose of this study is to describe the implementation and analysis of an alternate care site (ACS) to facilitate patient flow during winter volume surges. 
METHODS: An ACS was selected because of its size, temporary nature, low cost, and proximity to ED. The ACS was activated during winter 2018-2019 when criteria was met: total number of patients in waiting room ≥30 and wait times ≥ 2.5 hours. Outcome metrics included: total census, length of stay (LOS) - admissions, LOS - discharges, left without being seen (LWOBs), and hours per patient volume (HPPV).
RESULTS: Results are presented in Table 1. The ACS was activated five times over one season. The ACS decreased median waiting times, LOS - admissions, LOS discharges, and LOWBs as compared to previous year. HPPV remained constant as compared to previous year.
CONCLUSIONS: Based on our study, creating an ACS within the emergency department allowed a quick mobilization/response and treatment of patients. The ACS decreased median LOS for admissions and discharges as well as LWOBs while keeping HPPV constant. Future studies should test the ACS in additional hospitals and should evaluate cost, patient, and staff satisfaction.
TABLE 1. Effect of ACS Implementation on Emergency Department Metrics.

MetricJan-Mar 2018 w/o ACSJan-Mar 2019 (days meeting ACS criteria)% Change
Patient Volume (Average)290 patients282 patients-2.8%
Length of Stay Discharges (Median)199 minutes177 minutes-11%
Length of Stay Admissions (Median)282 minutes271 minutes-3.9%
Left Without Being Seen (Median)1.65%.8%-51%
HPPV (Median)1.91.90


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