The Impact of a Concierge Medicine Model on Door to Doctor Time and Patient Flow in an Urban Emergency Department

Figures & data

Table 1 Measured Time Intervals Stratified by Presence of a Brief Initial Assessment

Door To Doc
BIA	Median	Mean	SD	Prob(Lev_j>Lev_1)
N	62.4	83.4	[70..3]	0.5
Y	29	48.9	[51]	0.359
Doc To Decision
BIA	Median	Mean	SD	Prob(Lev_j>Lev_1)
N	176	198	[133]	0.5
Y	241	265	[173]	0.618
Door To Decision
BIA	Median	Mean	SD	Prob(Lev_j>Lev_1)
N	259	280	[147]	0.5
Y	294	314	[217]	0.547
Door To Disposition
BIA	Median	Mean	SD	Prob(Lev_j>Lev_1)
N	345	407	[276]	0.5
Y	378	439	[271]	0.521

Table 2 Characteristics by Patient Cohort

Age	Total	BIA = N			BIA = Y
		N		%	N		%
[18;65]	19,170	11,923		[71.4]	7247		[70.5]
[65;106]	7806	4774		[28.6]	3032		[29.5]
Triage Time
PM	17,450	8345		[50]	9105		[88.6]
AM	9526	8352		[50]	1174		[11.4]
Disposition
Admitted	8177		4955	[29.7]		3222	[31.3]
Discharge	18,799		11,742	[70.3]		7057	[68.7]

Table 3 Clinical Care Milestones Stratified by Presence of Brief Initial Assessment and Patient Disposition

A
All Days		Door to Doctor (Hrs)	Door to Decision (Hrs)	Doctor to Decision (Hrs)	Door to Disposition (Hrs)
Aug-oct, Concierge in Treatment area	Admitted Without BIA (n=2636)	1.48 (1.43,1.53)	5.17 (5.07,5.27)	3.75 (3.66,3.84)	10.10 (9.88,10.32)
	Discharged Without BIA (n=6069)	1.54 (1.51,1.58)	4.62 (4.56,4.68)	3.08 (3.03,3.14)	5.22 (5.14,5.29)
	Admitted with BIA (n=1466)	1.00 (0.95,1.05)	5.90 (5.62,6.18)	4.91 (4.63,5.18)	10.64 (10.38,10.89)
	Discharged with BIA (n=3195)	0.86 (0.83,0.90)	5.29 (5.20,5.38)	4.43 (4.35,4.51)	5.81 (5.71,5.95)
Nov-Jan, Concierge in Treatment and waiting Room	Admitted Without BIA (n=2328)	1.28 (1.24,1.32)	5.30 (4.93,5.12)	3.78 (3.69,3.87)	10.92 (5.71,5.92)
	Discharged Without BIA (n=5677)	1.34 (1.31,1.37)	4.47 (4.41,4.53)	3.13 (3.08,3.19)	5.08 (5.00,5.15)
	Admitted with BIA (n=1756)	0.88 (0.85,0.92)	5.59 (5.45,5.69)	4.68 (4.57,4.80)	11.42 (11.6,11.68)
	Discharged with BIA (n=3872)	0.80 (0.77,0.82)	4.95 (4.88,5.02)	4.15 (4.10,4.22)	5.48 (5.40,5.57)

B
Weekends only		Door to Doctor (Hrs)	Door to Decision (Hrs)	Doctor to Decision (Hrs)	Door to Disposition (Hrs)
Aug-Oct, Concierge in Treatment area	Admitted Without BIA (n=619)	1.56 (1.47,1.66)	5.21 (5.03,5.40)	3.70 (3.54,3.86)	9.11 (8.78,9.44)
	Discharged Without BIA (n=1911)	1.74 (1.68,1.80)	4.80 (4.69,4.92)	3.07 (2.97,3.16)	5.38 (5.25,5.41)
	Admitted with BIA (n=194)	1.65 (1.49,1.80)	6.42 (6.06,6.77)	4.80 (4.47,5.13)	10.28 (9.46,10.92)
	Discharged with BIA (n=434)	1.74 (1.65,1.83)	5.86 (5.63,6.09)	4.13 (3.92,4.34)	6.40 (6.13,6.66)
Nov-Jan Concierge in Treatment and waiting Room	Admitted with BIA (n=535)	1.33 (1.24,1.41)	5.09 (4.88,5.29)	3.78 (3.59,3.96)	9.01 (8.60,9.42)
	Discharged Without BIA (n=1594)	1.34 (1.29,1.39)	4.46 (4.35,4.57)	3.13 (3.03,3.24)	5.07 (4.94,5.19)
	Admitted with BIA (n=329)	1.20 (1.11,1.29)	5.87 (5.61,6.13)	4.67 (4.42,4.93)	9.57 (9.12,10.02)
	Discharged with BIA (n=798)	1.21 (1.15,1.27)	5.33 (5.17,5.48)	4.11 (3.96,4.26)	5.96 (5.77,6.13)