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

Background: Front-end care initiation (CI) systems in adult emergency departments (EDs) reduce wait times and improve patient flow but are novel in pediatric EDs with limited documentation 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.

Objectives: This study aimed to understand how CI affects patient and family experience and to evaluate its impact on throughput measures in our department.

Design/Methods: We conducted a matched retrospective cohort study of patients seen through CI from October 2023-June 2024 who completed the NRC Health Real-Time Patient Survey. 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 measure of patients’ likelihood of recommending our facility, calculated by subtracting the percentage of detractors (scores 0-6) from the percentage of promoters (scores 9-10). 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 CI patients were included with 61 patients excluded due to inadequate matches. 585 control patients were included. 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). The CI cohort had a greater proportion of Spanish speaking patients (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) than 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).

Conclusions: The CI cohort had a higher NPS score, suggesting 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. The CI group had shorter ED stays. This process is associated with an improvement in patient experience metrics and our ED throughput.